Nocardia scleritis-clinical presentation and management: a report of three cases and review of literature

Abstract

Aim: This study aims to describe the clinical features and management of Nocardia scleritis.

Methods: The authors retrospectively reviewed medical charts of three patients with microbiologically proven Nocardia scleritis and reviewed literature.

Results: All the patients presented with areas of well-demarcated, circumscribed abscess. No specific clinical feature could be attributed to the causative organism. Nocardia was identified by smear and culture from the scleral exudates. The medical management was based on the antibiotic sensitivity. Surgical exploration of the suppurated area along with the healthy margins was done on all patients. Two patients required multiple explorations. All three patients resolved with a good visual and tectonic outcome. The literature review also suggests a good outcome with prolonged medical management though the preferred antibiotic has changed over the years.

Conclusion: Though the prevalence of a disease like Nocardia scleritis is low, the results suggest that specific diagnosis and appropriate management can lead to a good outcome.

Fig. 1

Patient no. 2. a Slit lamp picture showing an area of circumscribed scleral abscess. A scleral ulcer is situated inferior to the abscess. b Scleral scraping showing thin, branching, acid fast filaments (arrow) suggestive of Nocardia species (Kinyoun’s acid fast stain using 1% H₂SO_4, ×1,000). c Three weeks after treatment decipitating uveal show. d Healthy and vascularized graft 4 months after scleral patch graft