Abstract
Nocardia is a gram-positive, immobile, aerobically growing filamentous bacteria. Nocardia keratitis is rare. Ocular trauma is the most common risk factor. Infection following keratorefractive procedures have also been reported. It runs an indolent course and is often misdiagnosed due to its atypical clinical presentation. Around half of the cases presents with the characteristic pinhead-shaped superficial corneal infiltrate and wreath-like pattern of patchy anterior stromal infiltrate. Other presentations include pseudo-dendritic corneal ulcer, satellite lesions, large corneal ulcer with overhanging edges, persistent epithelial defect, full-thickness corneal infiltrate, and deep stromal infiltrate with endothelial plaque. Gram-positive branching filamentous bacteria with 1% acid-fast staining are the key findings for its microbiological diagnosis. Confocal microscopy can help in early diagnosis of cases. Topical amikacin is the mainstay of treatment, and most of the cases respond well to medical therapy. Topical steroids should be avoided in cases of Nocardia keratitis. Familiarity with the clinical manifestations, early diagnosis, and appropriate treatment holds the clue for excellent outcome in a case of keratitis due to Nocardia species.
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Sahay, P., Maharana, P.K., Sharma, N. (2021). Nocardia Keratitis. In: Das, S., Jhanji, V. (eds) Infections of the Cornea and Conjunctiva. Springer, Singapore. https://doi.org/10.1007/978-981-15-8811-2_8
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