case_images: PMC11810137_01
case_images: (A) Photograph on the patient's right periocular region showing edema and erythema of the medial aspect of the right upper and lower eyelids. (B) Comparison of the right and left periocular regions, with absence of inflammatory signs on the left side.
case_images: cureus-0017-00000077259-i01.jpg
case_images: PMC11810137_01_cureus-0017-00000077259-i01.jpg
case_images: FIG1
case_images: However, there was persistent swelling of the right canalicular region, although reduced, as well as an associated grainy punctal discharge (Figure 1A, 1B).
case_images: Photograph of the operative field showing canalicular concretions expressed during curettage.
case_images: cureus-0017-00000077259-i02.jpg
case_images: PMC11810137_01_cureus-0017-00000077259-i02.jpg
case_images: FIG2
case_images: A horizontal incision was made along the canaliculus 1 mm from the punctum followed by curettage of concretions (Figure 2). 
case_images: (A) Photograph at one month postoperatively showing complete resolution of eyelid swelling, edema, and discharge. (B) Comparison of right and left periocular areas. (C) Closer view of the canalicular region showing good apposition of eyelids to the globe. (D) Eversion of the right lower eyelid showing absence of punctal swelling, hyperemia, and discharge. (E) Eversion of the right upper eyelid showing absence of punctal swelling, hyperemia, and discharge.
case_images: cureus-0017-00000077259-i03.jpg
case_images: PMC11810137_01_cureus-0017-00000077259-i03.jpg
case_images: FIG3
case_images: There was a complete resolution of symptoms on the last day of follow-up, with a positive fluorescein dye disappearance test and Zappia and Milder grading 1 (Figure 3A-3E).
case_images: Microscopy of the canalicular concretions showing numerous Gram-negative bacilli (Gram stain with retention of Safranin dye, oil immersion, x1000).
case_images: cureus-0017-00000077259-i04.jpg
case_images: PMC11810137_01_cureus-0017-00000077259-i04.jpg
case_images: FIG4
case_images: Microbiological studies of the canalicular concretions revealed exudative material with numerous Gram-negative bacilli (Figure 4).