Eyelid Nocardiosis After Lower Blepharoplasty

The authors present a case of eyelid nocardiosis following lower eyelid transconjunctival transposition blepharoplasty with externalized transposition sutures. After incision and drainage of the abscess, microbial cultures revealed Nocardia asteroides. Oral trimethoprim-sulfamethoxazole was initiated, leading to resolution of the infection. Nocardia can impact multiple organ systems and cause disseminated disease, most commonly affecting the immunocompromised. However, cutaneous nocardiosis has been described in immunocompetent patients. The species N. asteroides typically spreads hematogenously, rather than through direct cutaneous inoculation. Eyelid surgeons should be aware of the rare possibility of Nocardia infection in patients who develop signs of postoperative eyelid cellulitis or abscess following routine surgery and should recognize the importance of timely, appropriate antibiotic therapy to prevent adverse outcomes.