Mycobacterium abscessus infection of an anophthalmic socket associated with progressive cicatricial contracture

Nontuberculous mycobacteria may cause indolent postoperative or device-associated infection and can be overlooked in anophthalmic socket inflammation. A 71-year-old woman with a right anophthalmic socket reconstructed with a dermis-fat graft developed progressive inability to retain her prosthesis, followed by purulent discharge. Socket swab was acid-fast smear-positive and subsequently identified as Mycobacterium abscessus species group. Orbital magnetic resonance imaging showed mild curvilinear enhancement along the prosthesis margins without drainable abscess. Management included prolonged susceptibility-guided multidrug antimicrobial therapy in collaboration with the infectious disease team, with staged oculoplastic procedures for concurrent cicatricial contracture. Symptoms improved, a new prosthesis was fitted approximately 3 months after presentation, and the socket remained clinically quiet through approximately 15 months of follow-up. This case highlights atypical mycobacterial infection as a diagnostic consideration in persistent anophthalmic socket inflammation with progressive contracture.