Canaliculitis is a rare chronic inflammation or infection of the lacrimal canaliculus. Etiologies include a canalicular foreign body (eg, punctual plug, dacryolith), canalicular diverticulum, or chemical stenotic obstruction such as from 5-fluorouracil or mitomycin-C. However, most cases are found to be idiopathic.

Canaliculitis can be caused by a bacterial, viral, or fungal pathogen. The most common pathogen is Actinomyces israelii (Streptothrix), an anaerobic filamentous gram-positive bacterium.

Patients typically present with chronic unilateral conjunctivitis, epiphora and/or mucopurulent discharge, lower eyelid erythema, and a red, pouting punctum. Canaliculitis is often mistaken for conjunctivitis, and patients describe being treated for months with topical antibiotics with no improvement.

Early diagnosis and prompt treatment with conservative therapies may lead to resolution without recurrence and without the need for invasive surgery.