Mycobacterial Keratitis

A patient presented 6 weeks after cataract surgery in her right eye for eye pain and blurred vision. She had had cataract surgery most recently in the right eye, but had cataract surgery in the left eye several weeks prior. Upon presentation she had been using moxifloxacin topical antibiotic drops every hour and her vision was 20/40 and intraocular pressure was 35 mmHg in the right eye. Pupils were minimally reactive and anterior segment exam was notable for a limbal relaxing incision (LRI) with a small epithelial defect and underlying infiltrate with corneal thinning and robust anterior chamber reaction (3+ cell and flare and keratic precipitates). Initial culture was negative, and she did not respond to fortified antibiotics. Anterior segment OCT and confocal microscopy did not reveal an etiology for the ulcer. A suture was passed through the infiltrate and cultured and grew Mycobacterium abscessus which was treated with topical amikacin, oral clarithromycin and topical azithromycin with good resolution of infection. At last follow up, patient’s vision was 20/30 and stable.

Presentation Date: 07/17/2025

Issue Date: 09/12/2025