A case series on chronic canaliculitis.
BACKGROUND
Primary chronic canaliculitis is an uncommon disease, which is often misdiagnosed and insufficiently treated. We present two cases of canaliculitis caused by two different organisms, Actinomycetes spp. and Arcanobacterium haemolyticum. To the best of our knowledge, canaliculitis due to Arcanobacterium haemolyticum has not been reported before.


METHODS
The two cases described in this series show typical clinical features of canaliculitis with an inflamed upper canaliculus, not responsive to topical antibiotics. Appropriate treatment was delayed as they were initially treated for conjunctivitis. Both patients were treated with a canaliculotomy, with curettage and subsequent treatment with topical and systemic penicillin. The contents were sent for microbiological examination.


RESULTS
There was complete resolution following treatment. Actinomyces spp. was grown from one patient as expected. However, in the second patient, Arcanobacterium haemolyticum was isolated. Although this organism was not expected, the patient did respond to similar, conventional treatment.


CONCLUSIONS
Actinomyces spp. is a cast-forming Gram-positive anaerobe. They are difficult to isolate and identify and can cause infections of hollow spaces with formation of canaliculiths. Arcanobacterium (Corynebacterium) haemolyticum closely resembles Actinomyces (Corynebacterium) pyogenes. Ocular infections reported with this organism include orbital cellulitis and subperiosteal abscesses. The difficulty encountered in the isolation and identification of these organisms is discussed and the need for thorough curettage in the treatment of persistent or recurrent canaliculitis is emphasised.


CONCLUSIONS
Chronic canaliculitis should be considered in any patient who presents with chronic or recurrent conjunctivitis. Definitive cure will not be affected until all concretions are removed, either at surgery or by mechanical expression.
Varma
Deepali
D
Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK. deepalivarma@hotmail.com
Chang
B
B
Musaad
Sahar
S
D000193:Actinomycetales Infections / Q000175:diagnosis / Q000188:drug therapy*; D000368:Aged; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003354:Corynebacterium Infections / Q000175:diagnosis / Q000188:drug therapy*; D003607:Dacryocystitis / Q000382:microbiology* / Q000628:therapy*; D003608:Dacryocystorhinostomy / Q000379:methods; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D010406:Penicillins / Q000627:therapeutic use*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D010406:Penicillins