Orbital nocardiosis in immunocompetent patients: a case series and review of the literature.

Orbital nocardiosis is an uncommon pyogranulomatous infection rarely reported in immunocompetent individuals. Trauma is a major predisposing factor. We describe three cases of orbital nocardiosis highlighting the clinical features, microbiological profile, and histopathological characteristics. This retrospective case series included patients with histopathological and microbiological confirmed orbital nocardiosis diagnosed between January 2016 and December 2025 across the L V Prasad Eye Institute network in India. Cases were identified through electronic medical records, and data on demographics, clinical features, imaging, and treatment were collected. Three immunocompetent patients (2 males, 1 female; age 34-58 years) presented with chronic orbital inflammation following remote trauma. Clinical findings included preseptal abscesses, diffuse orbital masses, discharging sinuses, bony erosions, and intracranial extension (in one case). Imaging showed ill-defined soft tissue lesions involving the lacrimal gland, paranasal sinuses, or orbital roof. Nocardia nova was confirmed by sequencing in one patient, and two patients had co-infection with Staphylococcus aureus. Treatment included surgical debridement, intravenous amikacin, and oral trimethoprim - sulfamethoxazole. Two patients achieved complete resolution, and one patient was lost to follow up. Orbital nocardiosis can occur in immunocompetent patients, particularly after trauma. Early suspicion, tissue diagnosis, and prolonged antimicrobial therapy are essential to improve outcomes.