Bilateral actinomycotic blepharokeratoconjunctivitis

Actinomycotic conjunctivitis is usually unilateral and secondary to canaliculitis. We report an unusual case of bilateral actinomycotic blepharokeratoconjunctivitis in the absence of canaliculitis. Keratitis occurred without any preceding ocular trauma. Both eyes had remissions and relapses in response to the antibiotic-steroid drops. Diagnosis of A. israelii infection was made on the basis of Gram staining, culture and biochemical characteristics. Complete excision of the conjunctival ulcer along with penicillin therapy resulted in cure. This case highlights that microorganisms of the order Actinomycetales should be considered in the differential diagnosis if conjunctivitis or keratitis shows a waxing and waning course.