Actinomyces canaliculitis: Diagnosis of a masquerading disease

Background: To review the diagnosis and management of seven cases of Actinomyces canaliculitis. Methods: Culture of discharge was performed in six of seven patients with Actinomyces canaliculitis using a PD Plus/F blood culture bottle. All patients were treated by canaliculotomy with curettage of dacryoliths, followed by treatment with systemic penicillin and Sulphacetamide drops over a period of 3-6 months. Part of the curetted concretions was fixed on a glass slide and part was sent to the laboratory for culture. Results: Four patients were women and three men with age ranging between 43 and 90 years. The average time lapse between onset of symptoms until diagnosis was 3 years. All cases presented with epiphora, chronic conjunctivitis, palpably thickened canaliculus, and yellow punctal discharge. Diagnosis was achieved by culture of discharge in three of six cases, culture of concretions in three of five cases, and staining of dacryoliths in all seven cases. Follow-up ranged between 12 and 48 months. The canaliculitis resolved completely and all patients have patent canalicula. Conclusions: Actinomyces canaliculitis presents with epiphora, chronic purulent conjunctivitis, a palpably thickened canaliculus, and yellow punctual discharge. In suspect cases canuliculotomy and curettage should be performed, although canalicular reconstruction is generally unnecessary. Culture of discharge and concretions using PD Plus/F blood culture medium gave improved results over accepted norms. Fixation of smeared concretions on a slide in alcohol is simple and is diagnostic of the disease. We recommend long-term systemic penicillin treatment in Actinomyces canaliculitis.