- Nasal conjunctival redness, swollen and pouting punctum, and a mucopurulent discharge with itching, tearing, and irritation.

- Digital pressure over the punctum results in a greenish-yellow exudate often followed by yellowish concretions.

- Gram stain of the exudate confirms diagnosis.

- Surgical drainage may be necessary if curettage fails.

- Definitive treatment is surgical; antibiotics may play a 2° role.

Usual Pathogens

A. israelii


Empiric Therapy Dose Duration
Remove granules    
Penicillin G 100,000U/mL ophthalmic solution qid 1 week
Erythromycin 500mg PO qid 10 days