Nocardia brasiliensis keratitis successfully treated with therapeutic lamellar keratectomy

A 36-year-old man sustained an indolent keratitis following a minor corneal trauma. Nocardia brasiliensis was isolated from cultures of the corneal scrapings. Fortified topical antibiotics, based on in vitro drug sensitivity testing, were intensively applied for weeks without clinical improvement. The patient underwent therapeutic lamellar keratectomy, which led to a rapid and complete resolution. The site of the keratectomy reepithelialized within 2 days and became a faint subepithelial haze thereafter. The visual acuity improved to 20/20 and there was no evidence of recurrence during the subsequent follow-up. It appears that lamellar keratectomy is a valuable treatment alternative for localized chronic nocardial keratitis.