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LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 864-865
Actinomycotic lacrimal canaliculitis


1 Department of Ophthalmology, Vasan Eye Care Centre, Saidapet, Chennai, India
2 Department of Microbiology, Saveetha Medical College, Thandalam, Kancheepuram District, Tamil Nadu - 602 105, India

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Date of Web Publication27-Oct-2010
 

How to cite this article:
Pande M, Mathew R, Ramprakash M, Kalyani M. Actinomycotic lacrimal canaliculitis. Indian J Pathol Microbiol 2010;53:864-5

How to cite this URL:
Pande M, Mathew R, Ramprakash M, Kalyani M. Actinomycotic lacrimal canaliculitis. Indian J Pathol Microbiol [serial online] 2010 [cited 2020 Nov 23];53:864-5. Available from: https://www.ijpmonline.org/text.asp?2010/53/4/864/72012


Sir,

Chronic canaliculitis is a rare infection usually caused by Actinomyces israeli. A. israeli is a cast-forming Gram positive anaerobe that is difficult to isolate and identify [1] . It can cause infection of hollow spaces (like canaliculus) with formation of canaliculiths.

A 52year-old non-diabetic woman presented with complaints of persistent redness, watering and discharge in her right eye of six months duration. She was treated elsewhere with topical antibiotics but to no avail. On examination, the right eye showed conjunctival congestion, more in nasal conjunctiva corresponding to lower medial canthus, pouting of lower punctum with erythema and swelling of peripunctal area [Figure 1]. On pressure, over lower canalicular area, yellowish cheesy discharge with concretions was expressed. Other parts of anterior and posterior segments were normal with pseudophakia. Left eye was normal.
Figure 1: Clinical photograph showing swelling in the right peripunctal area

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Microscopy of the expressed material showed, Gram positive, non-acid fast (with 1% and 20% sulfuric acid), branching and filamentous bacilli, suggestive of Actinomycetes species [Figure 2]. Aerobic and anaerobic cultures were negative perhaps because of previous chronic use of topical antibiotics.

Simple curettage was done through dilated punctum followed by lavaging the canaliculus with penicillin G 100,000 IU/ml and topical polymyxin-B. Patient was given oral Penicillin V 800 mg thrice daily for a week. As no significant improvement was seen, canaliculotomy was performed and multiple adherent canaliculiths were evacuated using a fine chalazion curette. The lacrimal drainage system was then lavaged with penicillin G solution 100,000 IU/ml. During the postoperative period, oral penicillin and topical polymyxin B were given for a period of four weeks. Following this procedure patient showed dramatic improvement and it completely resolved [Figure 3]. Steroids (injections / drops) were not used in this case before or after surgery.
Figure 2: Photo micro graph showing Gram positive branching filamentous bacilli in the discharge (Gram's stain, ×100)

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Figure 3: Clinical photograph after canaliculotomy

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Histological examination of canaliculiths confirmed that they were solid casts of Actinomycetes with typical branching and filamentous structures.

Chronic canaliculitis presents with persistent symptoms of chronic or recurrent unilateral conjunctivitis. Actinomycotic canaliculitis accounts for approximately 2% of all lacrimal drainage system diseases presenting with epiphora. Clinically it shows thickening of medial eyelid, pouting punctum and expressible canalicular debris [2] . Diagnosis is made by cytological examination of yellow cheesy material from canaliculus, which shows characteristics of Actinomycotic infection.

To conclude, chronic canaliculitis should be considered in any patient who presents with chronic or recurrent conjunctivitis [3] . In most cases, in addition to medical therapy, surgical removal of canaliculiths and granulations is necessary in management.

 
   References Top

1.McKellar MJ, Aburn NS. Cast forming Actinomyces isreali canaliculitis. Aust NZJ Ophthlmol 1997;25:301-3.   Back to cited text no. 1
    
2.Levecq L, Eloy P, Nollevaux MC, Kozyreff A, Guagnini AP, Collet S. Actinomycotic lacrimal canaliculitis: A case report. J Fr Ophtalmol 2006;29:47-50.   Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Varma D, Chang B, Musaad S. A case series on chronic canaliculitis. Orbit 2005;24:11-4.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  

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Correspondence Address:
M Kalyani
Department of Microbiology, Saveetha Medical College, Thandalam, Kancheepuram District, Tamil Nadu - 602 105
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.72012

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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[Pubmed] | [DOI]



 

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