Nocardia keratitis after small incision lenticule extraction (SMILE)

BMJ Case Rep. 2024 May 15;17(5):e259486. doi: 10.1136/bcr-2023-259486.


We report the case of a female patient in her late 20s who visited the clinic with concerns about poor vision, redness, watering and a burning sensation in her left eye 2 weeks after undergoing a small incision lenticule extraction. She had no history of systemic illness or immunosuppressed status. On slit lamp examination, she was found to have corneal stromal infiltrates in the interface at multiple locations. Given the clinical diagnosis of microbial keratitis, corneal scraping of the interface infiltrate was performed and sent for microbiological examination revealing gram-positive, thin, beaded filaments that were acid-fast positive and later identified by growth in culture media as Nocardia species. This case was managed successfully with the use of topical amikacin and systemic trimethoprim-sulfamethoxazole with complete resolution of infection.

Keywords: Anterior chamber; Eye; Infections.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Amikacin / administration & dosage
  • Amikacin / therapeutic use
  • Anti-Bacterial Agents* / therapeutic use
  • Eye Infections, Bacterial* / diagnosis
  • Eye Infections, Bacterial* / drug therapy
  • Eye Infections, Bacterial* / microbiology
  • Female
  • Humans
  • Keratitis* / diagnosis
  • Keratitis* / drug therapy
  • Keratitis* / microbiology
  • Keratitis* / surgery
  • Nocardia / isolation & purification
  • Nocardia Infections* / diagnosis
  • Nocardia Infections* / drug therapy
  • Surgical Wound Infection / diagnosis
  • Surgical Wound Infection / drug therapy
  • Surgical Wound Infection / microbiology
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use