Diagnosis and management of Nocardia keratitis.

We read with interest the recent article by Tendolkar et al. (5). We have been seeing and treating cases of Nocardia keratitis for a long time and have published our experiences previously (3, 4). We would like to share some of our observations on this condition for the benefit of JCM’s readers. Nocardia keratitis can occur in immunocompetent patients following minor trauma (3). While lagophthalmos may predispose patients to Nocardia keratitis, it is not specific for this organism. Lagophthalmos is known to predispose individuals to a variety of bacterial and fungal infections of the cornea (our unpublished experience). Cases of infectious keratitis are normally investigated by smear examination and culture of corneal scrapings. Gynecological and otolaryngological investigations are of little relevance. The treatment of Nocardia keratitis is quite well established, with amikacin emerging as the best drug (1) with the lowest MIC for Nocardia isolates from corneal ulcers. Traditionally used sulfa group drugs are now being replaced with aminoglycosides and biguanides (2). Systemic antibiotics have little role in the treatment of bacterial keratitis.