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  • Actinomyces israelii (gram-positive, anaerobic bacteria)


  • 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 consisting of yellowish sulphur granules (cheesy secretion) can be expressed by pressure on the canaliculus
  • Punctal plug?


  • Warm compresses, digital massage, and topical antibiotics (e.g. Floxal gtt 4x/d)
    • usually not curative
  • Consider intracanalicular irrigation with antibiotic (e.g. Floxal)
  • Usually surgery necessary: Canaliculotomy: linear incision into the conjunctival side of the canaliculus and curettage of the concretions, consider placing a silicone stent to avoid scarring


  • EyeWiki Canaliculitis
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)