Bilateral Nocardia Keratitis following Photorefractive Keratectomy

To report the clinical, confocal scan, and histopathologic features of bilateral Nocardia keratitis following photorefractive keratectomy (PRK).Case report: A 23-year-old girl underwent simultaneous bilateral PRK for myopia. On the third postoperative day, dense central infiltrates mainly involving the anterior stroma were noticed in both eyes. Clinical and confocal scan features were consistent with a diagnosis of Nocardia keratitis and topical amikacin eye drops 2% were started. Empirical antibiotic therapy was converted into specific therapy after confirming the definite diagnosis by clinical features and confocal scan. Due to poor response to medical therapy, lamellar keratectomy was performed in both eyes which shortened the treatment course. Histopathologic examination confirmed the initial diagnosis. Familiarity with the clinical and confocal scan features of Nocardia keratitis facilitates early diagnosis, proper management and hence a rapid clinical response.