This is an uncommon, chronic unilateral infection caused by Actinomycetes israelii, Candida albicans or Aspergillus. The lower canaliculus is affected more frequently than the upper one. It occurs exclusively in adults and causes a secondary purulent conjunctivitis.
Presentation is with a mildly red and irritated eye with a moderate discharge. The punctum - at the medial end of the posterior margin of the lid - usually pouts and material can be expressed from the canaliculus. Canicular stenosis results if untreated.
Curettage of necrotic material from the relevant canaliculus, followed by forceful irrigation is often effective. Canaliculotomy followed by appliance of iodine to the lining of the caniculus may be neccessary. Total obstruction necessitates use of an artifical tear duct for relief of epiphora.
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