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Abstract ID: 24-127
Assessment of Combined Surgical and Medicinal Approach for Actinomyces Canaliculitis: Treatment Outcomes
Irina Kornilova
Purpose
Canalicular stenosis is a leading cause of excessive tearing, also known as epiphora. The most common bacterial pathogen found in chronic canaliculitis cases is Actinomyces israelii, an anaerobic, filamentous, gram-positive bacterium. Chronic Actinomyces infection leads to the formation of fungal mycelia in the lacrimal pathway, potentially narrowing or blocking it. The canaliculi, being the narrowest part of the lacrimal drainage system, exhibit early clinical manifestations upon blockage. Moreover, secondary bacterial infections are a common reason for ophthalmologist visits. Early detection and prevention of this condition can avert total canalicular stenosis. This study evaluates the efficacy of a combined surgical and medicinal approach in treating Actinomyces canaliculitis.
Methods
From 2016 to 2023, eleven adult patients with a total of eleven affected eyes received treatment at the Riga Outpatient Ophthalmologic Department. These patients presented with symptoms of epiphora and purulent canaliculitis. The average time from symptom onset to diagnosis was three years. Diagnosis was established clinically and through bacteriological tests. Initially, all patients underwent punctoplasty and partial curettage to mitigate infection exacerbation. For the subsequent two weeks, patients received broad-spectrum topical/systemic antibacterial and antifungal therapy based on laboratory test results. The second stage of treatment involved surgical interventions, such as repunctoplasty or slit opening of the canaliculus. In two cases, repeat interventions were necessary after four weeks.
Results
Bacteriological tests of conjunctival samples revealed common microflora; however, Actinomyces mycelia were specifically identified in concrements from the canalicular lumen. All patients successfully recovered from inflammation with appropriate treatment, and long-term follow-up showed no recurrence of epiphora.
Conclusion
Early recognition and proper treatment of chronic actinomycosis can prevent irreversible canalicular stenosis, eliminating the need for more invasive and complex procedures.
Additional Authors
Ekaterina Kondratishko – AIWA Clinic VCA
Sofija Kornilova – AIWA Clinic VCA