A case of chronic lacrimal canaliculitis: revisiting the role of Actinomyces israelii.

Chronic suppurative lacrimal canaliculitis is an important cause of ocular surface discomfort. Being a relatively rare condition, it is commonly overlooked and undiagnosed for long periods of time. Actinomyces israelii is classically cited as the most common causative organism of canaliculitis,1 at the same time, isolation is difficult owing to the anaerobic nature of the pathogen. Herein we present a case of chronic lacrimal canaliculitis successfully managed with the therapeutic triad of surgery, systemic antibiotics, and topical eye drops to increase awareness for this treatable condition. A 75-year-old male, retired personnel, presented with complaints of swelling at medial canthus of the left eye of one-year duration associated with pain, ocular discharge, redness, and watering. Prior to his visit at our hospital, he had consulted another hospital and received certain medications for his symptoms, but without relief. He was a known diabetic since 10 years, on oral glucose lowering agents and had primary open angle glaucoma. There was no history of trauma, or ocular surgery within the past six months. Ocular examination revealed swelling near left punctum associated with pouting of punctum with yellowish whitish material (sulfur granules) blocking the punctum. A Gram stain of the sulfur granules showed, Gram positive, non-acid fast, branching filaments, suggestive of Actinomyces species (Fig. 1A). Anaerobic culture