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Aetiology
- Actinomyces israelii (gram-positive, anaerobic bacteria), Staphylococcus, Streptococcus
Findings
- Epiphora with chronic mucopurulent conjunctivitis not responding to conventional therapy
- May have swollen lacrimal punctum
- Mucopurulent secretion when pressure is applied to the canaliculus
- Concretions can be expressed by pressure on the canaliculus
- Punctal plug?
Management
- Warm compresses, digital massage, and topical antibiotics (e.g. Floxal gtt 4x/d)
- only if diagnosis is uncertain, usually not curative
- Usually surgery necessary: Canaliculotomy: linear incision into the conjunctival side of the canaliculus and curettage of the concretions, swab for microbiological testing, consider placing a silicone stent to avoid scarring, consider intracanalicular irrigation with antibiotic (e.g. Floxal)
Differential Diagnosis
- Migrated punctal plug
- Dakryocystitis
- Caricnoma of the lacrimal canaliculus
- Chronic conjunctivitis
Sources