Bilateral Ocular Necrotizing Fasciitis in an Immunosuppressed Patient on Prescription Eye Drops

Preseptal cellulitis is an infection of ocular tissue that is often unilateral and caused by extension of sinonasal disease. In rare instances it can lead to life-threatening necrotizing fasciitis. We present here a unique case of bilateral preseptal cellulitis incited by local conjunctivitis caused by prescription eye drops. The patient was immunosuppressed, which allowed her local inflammation to progress to severe infection and, ultimately, to necrotizing fasciitis. This necessitated serial debridement by ophthalmology and otolaryngology teams and a prolonged course of intravenous antibiotics monitored by an infectious disease team. Despite these interventions, the patient’s vision did not return to baseline and she had persistent cosmetic and functional deformity. This case is unique due to the inciting incident of new prescription eye drops, the patient’s immunosuppressed state leading to severity of infection, and the severe bilateral disease burden.