Korean J Ophthalmol.  2013 Aug;27(4):291-293. 10.3341/kjo.2013.27.4.291.

Contact Lens-associated Nocardial Necrotizing Scleritis

• Rush RB

• KMID: 1705427
• DOI: http://doi.org/10.3341/kjo.2013.27.4.291

Abstract

A 52 year-old, contact lens-wearing man presented with progressive right eye pain and redness for one month. He had been evaluated and treated for necrotizing scleritis by multiple eye care specialists prior to presentation. He underwent a complete systemic work-up for both autoimmune and infectious causes of scleritis, including a culture. The culture revealed heavy growth of Nocardia asteroides complexes. The patient was treated with topical amikacin and oral Bactrim. Following several weeks of antibiotic treatment, the patient's infection resolved completely, and his visual acuity returned to baseline status. Nocardia is a rare but potentially devastating cause of necrotizing scleritis that may affect contact lens wearers without an associated keratitis. Prompt recognition and early treatment with appropriate antimicrobial agents are critical to achieve a favorable outcome.

Keyword

Contact lenses; Scleritis

MeSH Terms

Anti-Bacterial Agents/therapeutic use
Contact Lenses/*adverse effects/*microbiology
Humans
Male
Middle Aged
Nocardia Infections/*diagnosis/drug therapy
Nocardia asteroides/*isolation & purification
Scleritis/drug therapy/*microbiology
Anti-Bacterial Agents

Figure

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  Fig. 1 An external slit lamp photograph of the right eye on initial presentation with attention to the avascular sclera patch.

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  Fig. 2 An external slit lamp photograph of the right eye one week after the culture.

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  Fig. 3 An external slit lamp photograph of the right eye three months after the culture.

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