Actinomycosis in Ophthalmology Workup

Updated: Mar 15, 2016
  • Author: Manolette R Roque, MD, MBA, FPAO; Chief Editor: Hampton Roy, Sr, MD  more...
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Workup

Laboratory Studies

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  • Canalicular discharge and canaliculiths

    • Gram stain/Giemsa stain

    • Cultures and sensitivities (ie, blood agar, Sabouraud, anaerobic)

    • Special stains (ie, calcofluor white)

  • Smears and corneal scrapings

    • Ziehl-Neelsen stain

  • Anterior chamber (aqueous fluid) aspirate

    • Gram stain/Giemsa stain

    • Cultures and sensitivities (ie, blood agar, Sabouraud, anaerobic)

  • Vitreous samples

    • Gram stain/Giemsa stain

    • Cultures and sensitivities (ie, blood agar, Sabouraud, anaerobic)

    • Polymerase chain reaction

    • rRNA sequence analysis

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Imaging Studies

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  • Distension dacryocystography: Contrast material is used to visualize the anatomic details of the lacrimal drainage system.

  • Scanning electron microscopy

  • High-resolution ultrasound (transducer frequency of 20 MHz): The 20-MHz scanner images may reveal pathological findings that are invisible during a slit lamp examination. Ultrasonic images of chronic canaliculitis show ectasia of the canaliculus and sulfur grains measuring 1-2 mm in diameter. [33, 34, 35, 36]

  • Brain and orbital CT scan may be of use in cases of painful ophthalmoplegia.

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Other Tests

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  • Probing may be performed with a lacrimal probe to check for a diverticulum and remaining casts.

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Procedures

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  • Canaliculitis

    • A 2-snip punctoplasty may be performed under anesthesia.

    • Curettage may also be helpful in removing any adherent casts from the canaliculus.

    • Subsequent lacrimal irrigation with 2 MU of penicillin in 20 mL of sterile water may be helpful.

  • Endophthalmitis: A diagnostic and therapeutic, 3-port, pars plana vitrectomy may be performed in cases where a diagnosis has not been achieved.

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Histologic Findings

Histologic examination of the canaliculiths demonstrated that they consisted of solid casts of Actinomycetes with typical branching and filamentous structures. The organisms were found by using a Gram stain on the histopathologic preparations and by using a scanning electron microscopy.

Electron microscopic results of an actinomycosis of the lacrimal canaliculus were presented in 1980. The interior of the actinomycotic conglomerate showed no evidence of a cellular defense reaction, but, in the loosely woven outer network of hyphae, a massive granulocytic reaction was observed to be present. After phagocytosis, the structure of the actinomycotic microorganisms within the granulocytes was not significantly damaged. Within the tissue of the lacrimal canaliculus, adjacent to the actinomycotic conglomerate, an increased number of plasma cells were observed to be present; however, no organisms were present.

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