Nocardia eye” means an eye infection caused by Nocardia bacteria. It most often affects the cornea (the clear front window of the eye) and can sometimes involve the sclera (the white of the eye) or the inside of the eye (endophthalmitis). It usually happens after minor eye trauma or contact-lens problems, and it is more common in people with weakened immune systems.
Nocardia are branching, filament-like bacteria that live in soil and dust. They are aerobic, gram-positive on routine stains, and weakly acid-fast on special stains. When these bacteria enter the eye—most often through a tiny scratch in the cornea (for example, from a plant leaf, dusty wind, or a contact lens mishap)—they can cause infection. Doctors call this ocular nocardiosis. The usual form is Nocardia keratitis (infection of the cornea). Less commonly, the infection involves the white outer coat of the eye (nocardial scleritis) or the inside of the eye (endogenous or exogenous endophthalmitis). People with suppressed immunity (for example, on high-dose steroids, chemotherapy, or with transplants) are at higher risk for severe disease. NCBICDC Travelers’ HealthCDC
Nocardia eye” means an eye infection caused by a bacterium called Nocardia. These bacteria live in soil, dust, water, and decaying plants. They are filament-like, aerobic, and weakly acid-fast, which is a special staining behavior doctors see under the microscope. In the eye, Nocardia most often infects the cornea (the clear front window of the eye). This is called Nocardia keratitis. In rarer cases, it can reach deeper parts of the eye and cause endophthalmitis, or it can inflame the white coat (scleritis) or nearby tear ducts and tissues. Nocardia eye infections are uncommon, but they can threaten vision if not recognized and treated quickly. NCBIEyeWikiNature
Most eye cases start when the germ is introduced from the outside. This can happen after a scratch with soil or a plant twig, after contact lens problems, or after eye surgery. Much more rarely, the infection spreads to the eye from the bloodstream when a person has Nocardia somewhere else in the body (this is called endogenous infection). Endogenous ocular nocardiosis is uncommon, usually affects one eye, and is often linked to reduced immunity. PMC
Doctors pay attention to Nocardia because it can mimic other infections (like fungus) and it can be misdiagnosed. Certain clues help, such as tiny yellow-white, pin-head dots and a “wreath-like” ring of infiltrates in the cornea, but no single sign proves it on its own. A lab test is needed to confirm it. EyeWikiStatPearls
Although uncommon, Nocardia shows up across a spectrum of eye problems: keratitis, keratoconjunctivitis, scleritis, canaliculitis or dacryocystitis (tear system), orbital cellulitis, and both exogenous (outside-in) and endogenous (blood-borne) endophthalmitis. PMCNature
Even though Nocardia eye infections are rare (for example, Nocardia causes under ~2% of microbial keratitis worldwide), they can be stubborn and require specific antibiotics. Good history, careful exam, and microbiology are essential to avoid delays. SpringerOpen
Types of Nocardia Eye
Nocardia keratitis (corneal infection)
The cornea becomes inflamed and infected. Patients feel pain, light sensitivity, and blurred vision. Doctors may see a fine, dotted pattern and sometimes a classic wreath-like ring of tiny spots near the front layers of the cornea.Keratoconjunctivitis
The infection involves both the clear cornea and the conjunctiva (the thin membrane over the white of the eye and inside the lids). Eyes look red, irritated, and watery.Scleritis
The infection inflames the white wall of the eye. Pain can be deep and severe, often worse at night or with eye movement. The eye looks very red, and the white part can show tender, localized, sometimes purulent areas.Episcleritis (rare)
A milder, more surface-level inflammation than scleritis. Redness and discomfort are present but pain is less intense. Nocardia is a rare cause.Dacryocystitis (tear sac infection)
The area at the inner corner of the eye gets swollen, red, and painful. Pressing can push pus from the tear duct opening.Canaliculitis (tear canal infection)
The small channel that drains tears near the inner eyelid gets infected. There may be chronic, one-sided tearing and discharge with tenderness near the inner lid margin.Blepharitis/eyelid infection (rare)
The lid margins get inflamed with crusting and irritation. Nocardia is an uncommon cause but can occur.Orbital cellulitis
Infection spreads behind the eye. There is eyelid swelling, pain, fever, and sometimes eye movement pain and double vision. This is serious and needs urgent care.Exogenous endophthalmitis
Bacteria enter the eye after an injury or surgery. Vision drops, pain rises, and the eye can fill with inflammatory cells. This is an emergency.Endogenous endophthalmitis
Bacteria reach the eye via the bloodstream from infection elsewhere in the body. People with weak immune systems are at higher risk. Vision can decline quickly with floaters and light sensitivity. PMCJAMA Network
Causes
Each “cause” below is a pathway or condition that lets Nocardia enter the eye or overcome its defenses.
Corneal trauma with soil or plant matter
A twig, grain, leaf, or dust hits the eye and drives soil-borne Nocardia into the cornea.Contact lens over-wear
Sleeping in lenses, swimming with lenses, or poor hygiene can let environmental Nocardia stick and invade.Contaminated lens cases or solutions
Poorly cleaned cases or old solutions can harbor bacteria that transfer to the eye.Refractive procedures (e.g., PRK/LASIK) with surface disruption
A healing cornea is more vulnerable if germs contact it.Cataract or other intraocular surgery
A wound is a temporary entry point if bacteria contaminate the field or arrive later.Penetrating eye injury
A sharp foreign body carries germs deep into the eye and can seed endophthalmitis.Ocular surface disease
Conditions like severe dry eye or neurotrophic cornea reduce natural defenses and let bacteria adhere.Topical steroid overuse
Steroids can dampen local immunity and mask early infection signs, allowing Nocardia to multiply.Chronic eyelid margin disease
Long-standing crusting and inflammation can disrupt normal barriers.Tear drainage problems
Stagnant tears in blocked ducts can nurture bacteria that reflux toward the eye.Exposure to dusty, agricultural, or construction environments
Repeated eye exposure to soil and dust increases risk of minor abrasions and inoculation.Water exposure
Untreated water sources or splashes to the eye may carry Nocardia.Systemic immunosuppression
Chemotherapy, long-term systemic steroids, biologics, or advanced diabetes reduce whole-body defenses.Organ transplantation or HIV with low CD4
Major immune compromise raises risk of Nocardia in lung/skin with possible eye spread.Pulmonary or cutaneous nocardiosis with bloodstream spread
Infection elsewhere seeds the eye (endogenous endophthalmitis).Foreign body under the lid
A retained tiny particle rubs and breaks the surface, creating a gateway for bacteria.Delayed care after minor eye injury
Waiting and self-treating with old drops can let infection take hold.Inadequate cleaning after dusty sports or travel
Rubbing the eye with dirty hands can push germs onto a compromised surface.Contaminated topical products
Very rarely, multi-use bottles or applicators can be contaminated.Previous ocular surgery scars or sutures
Irregular surfaces can harbor bacteria and reduce local defense.
(As context for several of these, Nocardia eye disease is linked to soil/plant exposure, trauma, contact lens issues, and is overall rare among microbial keratitis cases. Steroid response can differ from other bacterial ulcers, and endogenous spread is unusual but documented.) AAO JournalSpringerOpenNCBIPMCEyeWiki
Symptoms
Eye pain — from surface scratches or deeper inflammation.
Redness — inflamed surface blood vessels make the eye look red.
Light sensitivity (photophobia) — light feels harsh because the cornea is irritated.
Blurred vision — the cornea loses clarity or the inside of the eye becomes cloudy.
Tearing — the eye waters to protect itself.
Foreign-body sensation — it feels like “something is in the eye.”
Mucus or pus discharge — especially if the conjunctiva or tear ducts are involved.
Grittiness and burning — nerves in the cornea signal irritation.
Swelling of the eyelids — lids react to nearby infection or inflammation.
Severe, deep aching (with scleritis) — pain may spread to the brow or jaw and worsen at night.
White or gray spot on the cornea — a focal infiltrate that can look like tiny dots or a ring.
Decreased night vision or halos — the cornea scatters light when it is swollen.
Floaters (with endophthalmitis) — clumps of inflammatory cells inside the eye can drift across vision.
Headache — from eye strain or surrounding tissue inflammation.
Fever or malaise (sometimes) — especially if there is a broader body infection in endogenous cases. (Endogenous disease can present with decreased vision, pain, photophobia, and floaters.) JAMA Network
Diagnostic Tests
Below are the tests doctors use, grouped into five categories. Each item explains what the test is and why it matters in simple words. Together there are 20 tests.
A) Physical Exam
Visual acuity testing
Reading the eye chart shows how much the infection has affected vision and helps track recovery over time.External inspection
The doctor looks at the lids, lashes, and surrounding tissues for swelling, tenderness, discharge, and skin changes that might suggest extension to lids, tear sac, or orbit.Slit-lamp biomicroscopy
This bright microscope examines the cornea in fine detail. It can show pin-point yellow-white dots, shallow wreath-like rings, epithelial defects, or satellite lesions that may suggest Nocardia, although these signs are not unique to Nocardia. EyeWikiStatPearlsFluorescein staining
A harmless orange dye highlights scratches or open areas on the cornea under blue light. This helps outline ulcer borders and depth.Intraocular pressure (IOP) check
Pressure can change with inflammation or steroid use. Measuring IOP helps guide safe treatment and watch for complications.
B) Manual / Bedside Procedures
Eyelid eversion
Flipping the lid reveals hidden foreign bodies or canaliculus discharge. This is important if symptoms persist or are one-sided.Lacrimal sac compression (“regurgitation test”)
Gently pressing on the inner corner of the eye can push out discharge from an infected tear sac or canaliculus, hinting at dacryocystitis or canaliculitis.Ocular motility and palpation
Checking eye movements and gentle palpation look for pain with movement or firmness behind the eye, which can suggest deeper spread (e.g., orbital cellulitis).Seidel test
A focused fluorescein test to detect a leaking corneal wound after trauma or surgery; a leak raises infection risk and changes management.Diagnostic corneal scraping (collection step)
At the slit lamp, the doctor manually collects tiny samples from the edge and base of the ulcer using a sterile tool. This is the most important bedside step to get material for smears and cultures that confirm Nocardia.
C) Lab and Pathological Tests
Gram stain
A rapid dye test that shows bacteria on the smear and their shape. Nocardia can appear as branching, beaded filaments and may look gram-variable. This gives quick early clues.Modified acid-fast stain (e.g., Kinyoun stain)
This special stain highlights Nocardia’s weak acid-fast nature. A positive result supports Nocardia when seen with the right filamentous pattern. NCBICulture on appropriate media
Samples are placed on media like blood or chocolate agar (and sometimes other media) and watched for chalky, dry colonies that grow more slowly than many common bacteria. Growth allows exact identification and antibiotic susceptibility testing. NCBIMALDI-TOF mass spectrometry
This modern tool reads a protein “fingerprint” of the colony and can accurately identify Nocardia species faster than many older methods. PMCPCR / 16S rRNA gene sequencing
Molecular tests detect Nocardia DNA and help speciate difficult or slow-growing isolates, improving accuracy when routine culture is tricky. NCBIAntimicrobial susceptibility testing
The lab checks which antibiotics stop the growth of the patient’s Nocardia strain (for example, assessing responses to amikacin, TMP-SMX, etc.). Results guide targeted therapy and avoid resistance. (Studies have noted activity of agents like amikacin for ocular isolates; exact choices are tailored to the lab report.) Nature
D) Electrodiagnostic Tests
Electroretinogram (ERG)
This test measures the electrical response of the retina to flashes of light. In severe, deeper infections like endophthalmitis, it helps judge whether the retina is still functioning and whether recovery is likely.Visual evoked potential (VEP)
This measures the brain’s response to visual signals. If the optic nerve or visual pathways are affected or if the view is too cloudy to examine directly, VEP helps estimate visual potential.
E) Imaging Tests
B-scan ocular ultrasound
A probe on the closed eyelid sends sound waves to create images when the cornea is too cloudy to see through. It can show vitritis (inflammatory debris in the gel), retinal detachment, or abscesses in suspected endophthalmitis.Anterior segment OCT / UBM or CT/MRI in selected cases
Anterior segment OCT or ultrasound biomicroscopy (UBM) maps how deep the corneal infiltrate goes. If the infection seems to involve tissues behind the eye, CT or MRI of the orbit checks for orbital cellulitis or abscess and helps plan treatment. (Endogenous cases often need imaging beyond the eye to look for a source elsewhere.) PMC
Non-pharmacological treatments
These measures support medical therapy. They do not replace antibiotics. Your eye doctor will individualize them based on your exam.
Immediate eye protection (rigid shield, not a patch)
Purpose: prevent accidental rubbing and further trauma.
Mechanism: reduces mechanical irritation and secondary injury while medicine works.Stop contact lenses until fully healed
Purpose: remove a common source of micro-trauma and contamination.
Mechanism: eliminates a surface that can harbor bacteria and biofilm; allows oxygen to reach the cornea.Strict hygiene for eye-drop use
Purpose: avoid re-seeding bacteria.
Mechanism: clean hands, avoid touching bottle tip to lashes; one bottle per patient; discard if contaminated.Early microbiologic work-up (scraping for smears/culture, PCR if available)
Purpose: confirm Nocardia and guide antibiotic choice.
Mechanism: identifies organism and susceptibility so treatment is targeted. NCBIGentle mechanical debridement of necrotic epithelium (in clinic)
Purpose: decrease bacterial load and improve drop penetration.
Mechanism: removes devitalized tissue and biofilm, allowing antibiotics to reach the stroma. EyeWikiTemporary discontinuation of topical steroids (unless your specialist says otherwise)
Purpose: steroids can worsen active bacterial infection.
Mechanism: they suppress local immune response; in Nocardia, this may allow spread. (Steroids might be re-introduced later, briefly, by specialists to limit scarring once infection is controlled.)Lubrication with preservative-free artificial tears
Purpose: relieve pain and improve surface healing.
Mechanism: stabilizes tear film and reduces friction across the ulcer.Cold compresses and light avoidance
Purpose: ease pain and photophobia.
Mechanism: vasoconstriction and reduced corneal nerve stimulation.Systemic health optimization (glucose, nutrition, sleep)
Purpose: support immune function.
Mechanism: better glycemic control and adequate protein/vitamins assist wound and immune responses.Treat blepharitis/meibomian gland dysfunction
Purpose: reduce bacterial load on lids that can re-seed the cornea.
Mechanism: lid hygiene, warm compresses (once infection is under control), and professional lid care.Avoid swimming or contaminated water exposure
Purpose: prevent additional microbes and irritants entering the eye.
Mechanism: cuts off a route for re-infection.Pain control with systemic analgesics (non-opioid)
Purpose: comfort to maintain adherence to frequent eye-drop schedules.
Mechanism: central pain modulation; does not slow healing when used appropriately.Adherence coaching and written schedules
Purpose: fortified antibiotics are often dosed hourly at first.
Mechanism: checklists/alarms improve compliance and outcomes.Protective eyewear during outdoor work and gardening (prevention during recovery)
Purpose: avoid re-injury while healing.
Mechanism: physical barrier from dust/soil/plant matter—common sources of Nocardia. CDCManagement of dry eye or exposure risk
Purpose: a healthier ocular surface heals faster, with fewer cracks for bacteria to enter.
Mechanism: moisture chamber glasses, lid taping at night if lagophthalmos, humidifier.In-vivo confocal microscopy (where available)
Purpose: non-invasive imaging can show filamentous organisms and help early diagnosis.
Mechanism: high-resolution imaging of corneal layers to support clinical suspicion before culture results. NCBIDiscontinue topical NSAIDs unless a cornea specialist recommends
Purpose: some topical NSAIDs can slow epithelial healing.
Mechanism: COX inhibition may delay re-epithelialization.Smoking cessation
Purpose: support immune function and oxygen delivery to tissue.
Mechanism: reduces oxidative stress and improves microvascular health.Eye-safe workplace adjustments
Purpose: reduce dust exposure during healing.
Mechanism: temporary role change, better ventilation, or personal protective equipment.Prompt escalation if not improving (don’t “wait it out”)
Purpose: Nocardia can be slow to respond; lack of early improvement may mean resistant species, deeper spread, or another diagnosis that needs a change in plan.
Mechanism: earlier change in antibiotics or surgery improves chances of saving vision. EyeWiki
Evidence-based drug treatments
Doses below are typical adult starting points and must be individualized by your ophthalmologist/infectious-disease specialist based on culture/susceptibility, kidney function, pregnancy, drug interactions, and disease depth. Children’s dosing differs. Duration often ranges from 3–6+ weeks for keratitis and longer for scleritis/endophthalmitis or systemic disease. PubMedSpringerOpenScienceDirect
Amikacin (aminoglycoside)
How used: Fortified topical 2–2.5% eye drops 1 drop hourly initially; may add intrastromal or intravitreal injection in severe/deep disease; IV reserved for systemic/disseminated cases.
Purpose/Mechanism: Blocks bacterial protein synthesis (30S ribosome). Particularly active against many Nocardia species in the cornea.
Side effects: Corneal epithelial toxicity with high frequency, pain/irritation; systemic forms can cause oto- and nephrotoxicity. EyeWikiSpringerOpenPMCTrimethoprim–Sulfamethoxazole (TMP-SMX; antifolate combo)
How used: Oral TMP 8–15 mg/kg/day (TMP component) divided BID–TID, often used for scleritis or deeper disease and as systemic coverage when there’s risk of spread; some centers also compound topical formulations.
Purpose/Mechanism: Sequential blockade of folate pathway → bactericidal synergy; good ocular and systemic activity for many Nocardia.
Side effects: Rash (including rare SJS/TEN), GI upset, hyperkalemia, bone-marrow suppression, photosensitivity. EyeWikiPubMedPMCLinezolid (oxazolidinone)
How used: Oral/IV 600 mg every 12 h for severe/intraocular/systemic disease; some centers use topical 0.2% compounded drops for keratitis.
Purpose/Mechanism: Inhibits 50S ribosomal initiation complex; excellent bioavailability and ocular penetration; active against many Nocardia.
Side effects: Myelosuppression (monitor CBC), peripheral/optic neuropathy with prolonged use, serotonin syndrome risk with SSRIs. NCBIWiley Online LibraryImipenem–Cilastatin (carbapenem)
How used: IV 500 mg every 6 h in severe or disseminated disease, sometimes combined with amikacin or TMP-SMX.
Purpose/Mechanism: Broad cell-wall synthesis inhibitor; hits many Nocardia species.
Side effects: Seizure risk at high doses/renal impairment; GI upset. NCBICeftriaxone or Cefotaxime (third-generation cephalosporins)
How used: IV (e.g., ceftriaxone 2 g daily) in selected systemic/severe cases while awaiting susceptibilities.
Purpose/Mechanism: Cell-wall inhibition; activity varies by species—best guided by culture results.
Side effects: Biliary sludging (ceftriaxone), allergy, GI upset. NCBIMinocycline (tetracycline class)
How used: 100 mg orally twice daily as an alternative or combination agent for susceptible strains.
Purpose/Mechanism: 30S ribosome inhibitor; some Nocardia strains are susceptible; good tissue penetration.
Side effects: Dizziness, photosensitivity, tooth discoloration (avoid in pregnancy/children). NCBIDoxycycline (tetracycline class)
How used: 100 mg orally twice daily for susceptible strains or when minocycline is not tolerated.
Purpose/Mechanism: As above.
Side effects: Photosensitivity, GI irritation, esophagitis (take with water, remain upright). NCBIMoxifloxacin (fluoroquinolone)
How used: 400 mg orally daily or topical 0.5% as adjunct in some cases, recognizing variable susceptibility; not a reliable monotherapy for Nocardia.
Purpose/Mechanism: DNA gyrase/topoisomerase inhibitor.
Side effects: Tendinopathy (rare), QT prolongation; topical burning. PMCTigecycline (glycylcycline, IV)
How used: Loading 100 mg IV, then 50 mg IV every 12 h for difficult, multi-drug-resistant infections under specialist care.
Purpose/Mechanism: 30S ribosome inhibitor with broad activity; used as salvage in resistant Nocardia.
Side effects: Nausea/vomiting, liver enzyme rise. NCBIClarithromycin (macrolide)
How used: 500 mg orally twice daily for susceptible species (e.g., N. brasiliensis) as part of combination therapy.
Purpose/Mechanism: 50S ribosome inhibition; susceptibility varies by species—use guided by culture.
Side effects: GI upset, drug interactions via CYP3A4. CDC Stacks
Duration notes: In published keratitis series using topical TMP-SMX, average treatment about 3–4 weeks; scleritis often needs weeks to months with combined topical + oral therapy and sometimes debridement; systemic/disseminated nocardiosis typically needs ≥ 3 months of effective oral/IV therapy—but ocular-only disease is often shorter when caught early. Your team will tailor duration to your response and lab results. PubMedPMCBMJ Case ReportsScienceDirect
Dietary molecular supplements
These do not treat Nocardia. They may support healing or immune balance when your doctor agrees and there are no interactions with your medicines.
Vitamin A: 2,500–3,000 IU/day (avoid high doses, avoid in pregnancy).
Function: supports corneal/epithelial health and mucosal immunity.
Mechanism: regulates epithelial gene expression and goblet cell function.Vitamin C: 500 mg twice daily.
Function: antioxidant; supports collagen formation in the healing cornea.
Mechanism: cofactor for prolyl/lysyl hydroxylase; scavenges reactive oxygen species.Vitamin D3: 1,000–2,000 IU/day (adjust to blood level).
Function: modulates innate and adaptive immunity.
Mechanism: vitamin-D receptor signaling in macrophages/epithelium.Zinc (elemental): 15–30 mg/day with food.
Function: innate immunity and epithelial repair.
Mechanism: cofactor for DNA synthesis and antioxidant enzymes.Selenium: 100–200 mcg/day.
Function: antioxidant (glutathione peroxidase).
Mechanism: limits oxidative injury around the ulcer.Omega-3 fatty acids (EPA+DHA): 1–2 g/day.
Function: supports tear film and anti-inflammatory balance.
Mechanism: eicosanoid signaling shifts toward pro-resolving mediators.Probiotics (e.g., Lactobacillus/Bifidobacterium): ≥10^9 CFU/day.
Function: gut–immune axis support, helpful during/after antibiotics.
Mechanism: improves microbial diversity and reduces antibiotic-associated diarrhea.N-Acetylcysteine (NAC): 600 mg 1–2×/day.
Function: antioxidant; mucolytic; sometimes used topically (specialist-directed) to break surface filaments/biofilms.
Mechanism: replenishes glutathione; reduces disulfide bonds in mucus/biofilm.Curcumin: 500–1,000 mg/day (with piperine for absorption).
Function: adjunct anti-inflammatory; may help with surface comfort.
Mechanism: NF-κB modulation and antioxidant effects.Lactoferrin: 200–300 mg/day.
Function: natural iron-binding protein with antimicrobial properties; supports ocular surface in dry-eye states.
Mechanism: deprives microbes of iron; modulates innate immunity.
Always review supplements with your clinicians to avoid drug interactions (for example, curcumin and clarithromycin interactions, or high-dose vitamin K affecting warfarin).
Immunity-supporting / regenerative” therapies
There are no approved “stem-cell drugs” to cure Nocardia. The items below are specialist-directed adjuncts used for specific problems (like severe immune suppression or ocular-surface damage). They are not first-line antibiotics.
Filgrastim (G-CSF)
Use: in severe neutropenia to raise neutrophils.
Dose: commonly 5 mcg/kg/day SC, adjusted by ANC.
Function/Mechanism: boosts marrow neutrophil production to help fight bacterial infections. Side effects: bone pain, leukocytosis.Interferon-γ-1b (for chronic granulomatous disease, selected cases)
Dose: 50 mcg/m² SC three times weekly (adult ceiling 50 mcg).
Function/Mechanism: activates macrophage microbicidal pathways; reduces severe infections in CGD. Side effects: flu-like symptoms.Intravenous Immunoglobulin (IVIG)
Use: in hypogammaglobulinemia or antibody defects.
Dose: often 0.4 g/kg monthly, adjusted to trough IgG.
Function/Mechanism: passive antibodies to support host defense. Side effects: headache, thrombosis risk in predisposed patients.Autologous serum eye drops (20–50%)
Use: epithelial non-healing after infection control.
Dose: 4–8×/day as directed.
Function/Mechanism: patient’s own growth factors (EGF, fibronectin) support corneal surface regeneration.Platelet-rich plasma (PRP) eye drops
Use: persistent epithelial defects and nerve discomfort once infection has cleared/controlled.
Function/Mechanism: platelet-derived growth factors (PDGF, TGF-β) promote epithelial and nerve repair.Cenegermin (recombinant human nerve growth factor) ophthalmic
Use: neurotrophic keratitis after severe corneal disease.
Dose: one drop 6×/day for 8 weeks.
Function/Mechanism: stimulates corneal nerve and epithelial healing; not an anti-Nocardia drug.
Surgeries
Therapeutic debridement / superficial keratectomy
What: careful removal of infected/necrotic corneal tissue.
Why: reduces organism load and lets antibiotics penetrate better; sometimes repeated early in the course. EyeWikiAmniotic membrane transplantation (AMT)
What: biological bandage placed on the cornea.
Why: promotes epithelial healing, decreases inflammation, protects the surface after infection begins to quiet.Therapeutic keratoplasty (partial-thickness DALK or full-thickness PK)
What: surgical replacement of infected or scarred cornea.
Why: removes non-responding infection or clears dense scarring that blocks vision; antibiotics are continued to prevent recurrence. EyeWikiPars plana vitrectomy (PPV)
What: microsurgery to remove infected vitreous gel from inside the eye.
Why: used in endophthalmitis to lower bacterial load, obtain samples, and allow intravitreal antibiotics (often amikacin) to act more effectively. PMCScleral debridement / patch grafting
What: removal of necrotic sclera; sometimes reinforced with a graft.
Why: for nocardial scleritis that is not settling; paired with prolonged topical amikacin and oral TMP-SMX. PMCBMJ Case Reports
Prevention tips
Wear wraparound eye protection during gardening, farming, woodworking, or dusty outdoor work (soil is the reservoir). CDC
Practice excellent contact-lens hygiene: no overnight wear (unless specifically prescribed), no tap water, rub-and-rinse, and replace cases regularly.
Do not use homemade saline or topped-off solutions.
Wash hands before any eye-drop or lens handling.
Seek care early after eye trauma—even tiny plant-related scratches.
Use topical steroids only when a clinician directs and never to “self-treat” a red, painful eye.
Control diabetes and other chronic conditions that impair wound healing.
If you are immunosuppressed, ask your doctor whether TMP-SMX prophylaxis (often used for PJP) is appropriate; it has been associated with reduced nocardiosis in high-risk groups. CDC Stacks
Avoid swimming or shower water in the affected eye during active infection.
Keep protective eyewear at work/home to make prevention effortless.
When to see a doctor—urgently
Eye pain, light sensitivity, tearing, or decreased vision after dust/soil exposure or contact-lens wear.
A white spot on the cornea, especially with a “cracked windshield” look, or any non-healing corneal scratch. PMC
Red, tender, thinning white of the eye (possible scleritis). PMC
Worsening symptoms after starting steroid eye drops without antibiotics.
Floaters, severe pain, or sudden vision loss (possible endophthalmitis). PMC
What to eat—and what to avoid—during recovery
Eat more of these (support healing):
Lean proteins (fish, poultry, legumes) for tissue repair.
Colorful vegetables and fruits (vitamin C, carotenoids).
Healthy fats (olive oil, nuts, seeds) plus omega-3-rich fish.
Fermented foods (yogurt, kefir, sauerkraut) to support the gut during antibiotics.
Hydration: water and broths to maintain tear production and comfort.
Limit/avoid these (reduce inflammation or interactions):
- Excess sugar and ultra-processed foods, which can hinder immune balance.
- Alcohol, especially with antibiotics (interaction risks and dehydration).
- Grapefruit if you’re taking clarithromycin or other CYP3A4-metabolized drugs (interaction).
- High-dose vitamin A without supervision (toxicity risk) and “mega-dose” supplements that interact with your meds.
- Unpasteurized products or raw sprouts if you’re immunosuppressed.
Frequently Asked Questions
1) Is Nocardia eye contagious?
No; it usually comes from the environment (soil/dust) entering the eye, not from another person. CDC
2) How is it different from fungal keratitis?
They can look similar, but Nocardia often shows fine, chalky, “cracked windshield” infiltrates and needs specific antibiotics rather than antifungals; lab tests help tell them apart. PMC
3) What is the first-line treatment?
For corneal disease, many centers start fortified amikacin eye drops; TMP-SMX is commonly used when deeper tissues are involved or as systemic therapy. Your exact plan depends on species and susceptibilities. EyeWikiSpringerOpen
4) Will I need oral or IV antibiotics?
Possibly—especially for scleritis, endophthalmitis, or if you’re immunosuppressed. Doctors may combine topical and systemic therapy. PMC+1
5) How long does treatment last?
Keratitis often needs weeks; deeper/systemic disease needs months. Doctors tailor duration to healing and culture results. PubMedScienceDirect
6) Do steroid eye drops help or hurt?
At the start, steroids can worsen bacterial infections. Specialists sometimes add a short steroid course later to limit scarring—only after bacteria are controlled.
7) What if it doesn’t improve in a few days?
Return promptly. Reasons include resistant species, insufficient drug penetration, or a different diagnosis. Your team may change medicines or perform debridement/keratoplasty. EyeWiki
8) Can I keep wearing contact lenses while treating it?
No. Lenses can worsen disease and block oxygen. You can discuss safe re-start after full healing.
9) What are the chances of full vision recovery?
Many patients do well with early, targeted therapy. Delay in care, deep ulcers, or endophthalmitis lowers the chance of full recovery. PMC
10) Are fluoroquinolone drops enough?
Not reliably—Nocardia susceptibility to fluoroquinolones is variable. They are usually not first-line monotherapy. PMC
11) Could this spread to the rest of my body?
It’s uncommon with isolated keratitis, but possible in immunosuppressed individuals or with endogenous endophthalmitis; that’s why doctors assess your overall health. NCBI
12) I’m on chemotherapy/transplant medications. Anything special?
Yes—your team may coordinate systemic antibiotics longer and consider prophylaxis or immune-support strategies. Never change immunosuppressants without your specialists. CDC Stacks
13) Can surgery cure it?
Surgery reduces the organism burden and removes damaged tissue; it works with antibiotics, not instead of them. PMC+1
14) Will it come back?
Recurrence is uncommon when therapy is long enough and the surface is fully healed. Follow-ups confirm eradication.
15) What follow-up schedule should I expect?
Often daily to every-few-days at first (because drops are frequent and the picture can change fast), then less often as you improve. Your schedule is individualized.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: August 15, 2025.
