A 38-year-old woman has a chronically swollen, slightly tender right lower eyelid for several months. The punctum appears pouted and hyperemic, and pressure beside it expresses yellowish granular material through the punctum. The tear film and drainage beyond the punctum are otherwise normal. The most likely causative organism is:
- A Staphylococcus aureus
- B Actinomyces israelii ✓
- C Haemophilus influenzae
- D Pseudomonas aeruginosa
Correct answer: B. Actinomyces israelii
Explanation
Chronic canaliculitis presents with unilateral tearing, a pouting 'pouting fish mouth' punctum, and expressible yellow sulfur granules, which are colonies of Actinomyces israelii, a filamentous anaerobic commensal. Treatment is canaliculotomy with removal of concretions followed by irrigation, since antibiotics alone fail behind the stones. Staphylococcus causes acute hordeolum and typical bacterial dacryocystitis with mucopurulent reflux from the sac rather than punctal granules.
Reference: Parsons' Diseases of the Eye, 23rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.