Aggregatibacter aphrophilus chronic lacrimal canaliculitis: a case report

Abstract

BackgroundChronic canaliculitis is often misdiagnosed as conjunctivitis, delaying proper documentation and management. Aggregatibacter aphrophillus has not been implicated in chronic canaliculitis.Case presentationWe report a case of unilateral chronic epiphora associated with chronic lacrimal canaliculitis resistant to prolonged topical antibiotic treatment in a 65-year-old woman without notable medical history. Canaculotomy, curettage with removal of concretions and tubing with silicone stent for six weeks resolved this chronic infection. Culturing lacrimal secretions and concretions yielded Aggregatibacter aphrophilus in pure culture. Histological analyses showed elongated seed clusters surrounded by neutrophils. Fluorescence in Situ Hybridization confirmed the presence of bacteria in two distinctive concretions.ConclusionThis first documented case of A. aphrophilus chronic lacrimal canaliculitis illustrates that optimal surgical management of chronic lacrimal canaliculitis allows for both accurate microbiological diagnosis and treatment.

Bleeding From the Eye: An Unusual Presentation of Lacrimal Canaliculitis

“…In the majority of cases, only a single duct is involved, with the lower lacrimal duct most frequently affected [ 2 ] and its prevalence is higher in women [ 3 ]. Chronic lacrimal canaliculitis accounts for 2% of lacrimal duct disease [ 4 ]. Due to its classical symptoms mimicking more common pathologies such as chronic conjunctivitis, chalazion, hordeolum or chronic dacrocystitis [ 5 ], diagnosis is often delayed and the mean duration of these symptoms until the time of diagnosis is 10 months [ 6 ].…”

“…Initial treatment options typically involve a course of topical antibiotics such as fluoroquinolone; however, this is often ineffective due to chronically colonized concretions [ 4 ]. Surgery with a canaliculotomy and curettage of these concretions or punctoplasty is frequently needed as a curative measure.…”