• David R Shield, Javier Servat, Sean Paul, Roger E Turbin, Annie Moreau, Adam de la Garza, Edward El Rassi, Jonathan Silbert, Robert Lesser, and Flora Levin.
• Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut.
• JAMA Ophthalmol. 2013 Sep 1;131(9):1225-7.

ImportancePeriocular necrotizing fasciitis is a rare but potentially devastating disease, accompanied by high rates of morbidity and mortality.ObservationsWe report 5 cases of periocular necrotizing fasciitis resulting in severe vision loss, 3 of which required exenteration to contain the disease and only 1 of which recovered vision. Three cases were caused by group A streptococcus; 1, by methicillin-resistant Staphylococcus aureus; and 1, by Streptococcus anginosus constellatus.Conclusions And RelevanceProviders should maintain a high clinical suspicion for necrotizing fasciitis and distinguish it from more common forms of cellulitis. As seen in these 5 cases, periocular necrotizing fasciitis may cause severe visual loss more often than previously recognized. To our knowledge, this is also the first report of Streptococcus anginosus constellatus causing necrotizing fasciitis.

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