Nocardia asteroides keratitis associated with extended-wear soft contact lenses

Chronic unilateral keratitis developed in a 34-year-old woman who wore extended-wear contact lenses. A clinical response was not obtained until Nocardia asteroides was correctly identified as the causal agent. The response to 30% sulfacetamide was dramatic. We review the clinical presentation of Nocardia keratitis and recommendations for management. Use of corticosteroids should be avoided in Nocardia keratitis. This opportunistic organism should be considered in patients who wear contact lenses in whom infectious keratitis develops.