title: Necrotizing Fasciitis of the Periorbital Region Complicated by Combined Central Retinal Artery Occlusion, Central Retinal Vein Occlusion, and Posterior Ciliary Occlusion.
abstract: A 50 year-old man on immunosuppressive agents presented with left eye vision loss, periorbital swelling, pain, and ophthalmoplegia. The patient was clinically found to have a central retinal artery and vein occlusion. A CT scan was performed which demonstrated intraorbital fat stranding, however the patient lacked sinus disease. The etiology of the orbital infection was held in question. The area was debrided in the operating room, and the specimen demonstrated group A streptococcal species consistent with necrotizing fasciitis. Periorbital necrotizing fasciitis should be suspected in patients with rapidly progressive orbital symptoms without sinus disease as lack of surgical intervention can result in poor outcomes. The unusual aspect to this case is the mechanism of vision loss, as the authors hypothesize that there was vascular infiltration of the infection resulting in the central retinal artery occlusion and central retinal vein occlusion which have not been previously reported secondary to necrotizing fasciitis of the orbit.
authors.affiliation: *Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, †Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, ‡Community Retina Group, Houston, Texas; §Departments of Ophthalmology and Pathology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; ‖Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, New York, New York, ¶Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, #Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa; **The University of Texas MD Anderson Cancer Center, Houston, Texas; ††Department of Pathology, Genomic Medicine and Ophthalmology, Houston Methodist Hospital, Houston, Texas; ‡‡Department of Pathology and Laboratory Medicine and Ophthalmology, Weil Cornell Medical School, New York, New York; and §§Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Harris
authors.initials: H
authors.lastname: Sultan
authors.forename: Amina
authors.initials: A
authors.lastname: Malik
authors.forename: Helen K
authors.initials: HK
authors.lastname: Li
authors.forename: Patricia
authors.initials: P
authors.lastname: Chévez-Barrios
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Lee
mesh_terms: D019842:Ciliary Arteries / Q000000981:diagnostic imaging*; D015818:Eye Infections, Bacterial / Q000150:complications* / Q000175:diagnosis; D019115:Fasciitis, Necrotizing / Q000150:complications* / Q000175:diagnosis; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000150:complications* / Q000175:diagnosis; D015356:Retinal Artery Occlusion / Q000175:diagnosis / Q000209:etiology*; D012170:Retinal Vein Occlusion / Q000175:diagnosis / Q000209:etiology*; D013203:Staphylococcal Infections / Q000150:complications* / Q000175:diagnosis; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed