Nocardia keratitis after traumatic detachment of a laser in situ keratomileusis flap

PURPOSE: Nocardia are gram-positive bacteria existing ubiquitously in the e nvironment; they can cause keratitis. Nocardia asteroides keratitis occurre d in the interface between the stromal bed and flap after traumatic detachm ent of the flap 4 months after an initially uncomplicated laser in situ ker atomileusis (LASIK) procedure. METHODS: Nocardia asteroides keratitis was confirmed by culture. Therapy in cluded topical and oral trimethoprim-sulfamethoxazole. RESULTS: Thirteen months after the trauma, the patient's spectacle-correcte d visual acuity was 20/20 with a manifest refraction of -2.25 -1.00 x 30 de grees. CONCLUSIONS: The immediate steps of management consisting of surgically lif ting the corneal flap, rapid microbial identification, and proper treatment with specific antibiotics resulted in the successful treatment of Nocardia asteroides keratitis in a traumatized eye after LASIK.