title: Cast-forming Actinomyces israelii canaliculitis.
abstract: BACKGROUND
  Primary chronic canaliculitis is an uncommon disease usually caused by Actinomyces israelii (streptothrix). Actinomyces israelii is a cast-forming Gram-positive anaerobe that is difficult to isolate and identify. We present a case that demonstrates the typical clinicopathological presentation of this unusual condition and discuss management options.
  
  
  RESULTS
  A 10-year-old girl presented with a 6 month history of intermittent 'conjunctivitis' and discharge from her 'pouted' left lower punctum. Microbiology confirmed probable A. israelii infection, but topical treatment failed. Exploration under anaesthesia revealed a canalicular diverticulum and three canaliculiths. Histological examination of the canaliculiths demonstrated that they consisted of solid casts of Actinomyces. Punctoplasty, removal of the casts, and adjunct antibiotic therapy resulted in resolution of the canaliculitis.
  
  
  CONCLUSIONS
  Primary chronic canaliculitis should be considered in any patient who presents with chronic or recurrent conjunctivitis and the eyelid should be inspected for a discharging and 'pouting' punctum. Failure of the condition to resolve on topical treatment requires surgical exploration of the canalicular system and removal of any casts. Extensive surgery is not always required.
authors.affiliation: Department of Ophthalmology, Christchurch Hospital, New Zealand.
authors.forename: M J
authors.initials: MJ
authors.lastname: McKellar
authors.forename: N S
authors.initials: NS
authors.lastname: Aburn
mesh_terms: D000190:Actinomyces / Q000302:isolation & purification*; D000196:Actinomycosis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002908:Chronic Disease; D003231:Conjunctivitis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D003475:Curettage / Q000379:methods; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007765:Lacrimal Apparatus / Q000382:microbiology / Q000473:pathology; D007766:Lacrimal Apparatus Diseases / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D009883:Ophthalmic Solutions; D012008:Recurrence; D013518:Surgery, Plastic / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents; D009883:Ophthalmic Solutions