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a 47-year - old woman was a dmitted to o ur clinic for persistent purulent discharge from the left eye for a duration of six months .
she had been diagnosed with chronic conjunctivitis at a private eye clinic . despite conservative treatment , the symptom was persistent , leading to referral of this patient to our clinic .
her corrected visual acuity was 1.2 , and no specific findings were noted in her past medical history .
slit lamp examination showed discharge via a fistula in the central part of the caruncle of the left eye , a red and swollen caruncle , and mild hyperemic conjunctiva ( fig .
lacrimal drainage was patent to syringing and showed no reflux in the upper or lower canaliculus of the left eye .
computed tomography ( ct ) scan and magnetic resonance imaging ( mri ) showed an elliptical hypo - dense lesion of about 1 cm in diameter in the medial portion of the left lower eyelid ( fig .
intraoperative lacrimal probing and irrigation were performed to confirm that the abscess and canaliculus were not connected .
bacteria were not identified in the culture , but biopsy of the lesion confirmed a benign purulent cyst with ' sulfur granules ' by histopathologic examination ( fig .
postoperative oral and topical antibiotics were administered ; the lesion resolved with no evidence of recurrence within four months , and the symptom significantly improved .
actinomycosis is a chronic disease that spreads to surrounding tissues with the formation of abscesses and granulomas that are typically accompanied by microcolonies known as ' sulfur granules ' .
actinomyces is a genus of the actinobacteria , anaerobic gram - positive organisms that grow through the formation of hyphae .
the diagnosis of actinomycosis is confirmed microbiologically by the identification of actinomyces in a sample obtained from the lesion and pathologically by observing sulfur granules from tissue or an abscess .
actinomycosis is a relatively rare disease , and although some cases of orbital cellulitis and chronic endophthalmitis after cataract surgery were reported to generate cultured actinomyces [ 6 - 8 ] , most of the described cases have been canaliculitis .
actinomyces canaliculitis is usually accompanied by a mucopurulent punctal discharge , epiphora , inflammation of the medial canthus , a thickened canaliculus , and a red pouting punctum .
since the frequency of canaliculitis is low , it is often mistaken for refractory chronic or recurrent conjunctivitis , although differentiation is possible by confirming the presence of purulent discharge from the punctum .
the case under discussion was originally mistaken for chronic conjunctivitis due to erythema , swelling , and purulent discharge from the pericaruncular area . after failing to respond to treatment ,
the patient was referred to us . although canaliculitis can show a similar pattern , the purulent discharge was observed to not originate from the punctum , and a ct scan and mri identified a lesion near the lower eyelid , which led to a preoperative diagnosis of a caruncular abscess .
topical ciprofloxacin and oral penicillin antibiotics were administered postoperatively , and the erythema and swelling of the pericaruncular area gradually decreased ; purulent discharge was no longer observed .
reports of caruncle infection a re d ifficult to find , although koo and chang   reported a case of caruncular abscess with methicillin - resistant staphylococcus aureus , and pappalardo et al .  
reported granules of the caruncle caused by actinomycosis . to our knowledge , this is the first reported case of caruncular abscess with chronic purulent discharge caused by actinomycosis in korea .
the authors report a caruncular abscess caused by actinomycosis . 
 a 47-year - old woman was admitted with persistent purulent discharge from the caruncle of the left eye for a duration of six months . 
 excisional drainage was performed , and ' sulfur granules ' were observed , consistent with actinomyces infection . 
 intraoperative lacrimal probing and irrigation were performed to confirm that the abscess and canaliculus were not connected . 
 oral and topical antibiotics were administered postoperatively ; the lesion resolved with no evidence of recurrence , and the symptom improved .