A 31-year-old male wearer of extended-wear soft contact lenses had experienced a painful, red left eye for 3 days and sought medical care. Examination demonstrated multifocal keratitis that was denser centrally (Figure 1). Treatment with topical corticosteroids resulted in progression of epitheliopathy into confluent, ring-shaped lesions (Figures 2, 3, and 4). A wreathlike pattern of infiltration is described with Nocardia keratitis.1 A gritty sensation was observed on corneal scraping, a feature commonly associated with this entity.2 Gram staining demonstrated branching gram-positive rods, identified on culture as Nocardia farcinica. The keratitis was treated with topical ciprofloxacin hydrochloride and a topical combination of trimethoprim and sulfamethoxazole (intravenous solution), which has been reported to be effective.3 The patient’s final visual acuity was 20/40 OS, with some anterior stromal scarring (Figure 5). Nocardia typically grows slowly, and the characteristic features of the infiltrates should raise suspicion of Nocardia keratitis. Appropriate treatment should be instituted early to limit ocular morbidity.
Hoffman PM, Poon A, Snibson GR. Nocardia Keratitis in a Contact Lens Wearer. Arch Ophthalmol. 2005;123(12):1759. doi:10.1001/archopht.123.12.1759