A Para-Canalicular Abscess Resembling an Inflamed Chalazion

Abstract

Background. Lacrimal infections by Actinomyces are rare and commonly misdiagnosed for long periods of time. They account for 2% of all lacrimal diseases. Case Report. We report a case of a 70-year-old female patient suffering from a para-canalicular abscess in the medial canthus of the left eye, beside the lower punctum lacrimale, resembling a chalazion. Purulence exited from the punctum lacrimale due to inflammation of the inferior canaliculus (canaliculitis). When pressure was applied to the mass, a second exit of purulence was also observed under the palpebral conjunctiva below the lacrimal caruncle. A surgical excision was performed followed by administration of local antibiotic therapy. The histopathological examination of the extracted mass revealed the existence of actinomycosis. Conclusion. Persistent or recurrent infections and lumps of the eyelids should be thoroughly investigated. Actinomyces as a causative agent should be considered. Differential diagnosis is broad and should include canaliculitis, chalazion, and multiple types of neoplasias. For this reason, in nonconclusive cases, a histopathological examination should be performed.

Lacrimal canaliculitis

“…Additional findings with cases of secondary canaliculitis include an inflammatory mass projecting from the punctum or intermittent blood-stained tears 3, 5, 15, 14. Canaliculitis should be considered as a possible etiology with persistent or recurrent eyelid lesions, chalazia, or abscesses 16 …”

“…Microbiologic studies include aerobic and anaerobic cultures 9 . In recurrent cases with negative cultures, fungal and mycobacterial cultures may also be done 16 2, 6, 20.…”

“…3 , 5 , 15 , 14 Canaliculitis should be considered as a possible etiology with persistent or recurrent eyelid lesions, chalazia, or abscesses. 16 …”

Lacrimal canaliculitis- A case report

“…2,3,8 Canaliculitis should be considered as a possible etiology with persistent or recurrent eyelid lesions, chalazia, or abscesses. 9 A primary infection of the lacrimal canaliculus is relatively uncommon. Actinomycosis may form in up to 2% of all lacrimal disease.…”

Ocular Adnexal Infections

“…The canaliculitis literature consisted of a case report of Actinomyces para-canalicular abscess mimicking a chalazion [40]. Indeed, we too have encountered medial canthal chalazia mimicking canaliculitis as well as canaliculitis mimicking peripunctal chalazia.…”