OBJECTIVE To review the clinical findings, treatment outcomes, and microbiology of primary canaliculitis. METHODS A medical record database was queried to identify cases of primary canaliculitis. The 23 cases identified were reviewed for clinical presentation, treatment, microbiology, pathology, and patient outcome at the time of most recent follow-up. Participants were also surveyed to determine long-term treatment outcomes. RESULTS Twenty-three patients met the criteria for primary canaliculitis. The median duration of symptoms was 135 days. The most common symptoms were mattering and epiphora. Punctal regurgitation was the most common clinical finding. Seven patients had multiple canalicular involvement. Treatment included either medical therapy or surgical intervention. Cultures were obtained from 16 participants. Sixty-two percent of identified organisms were gram positive, and most organisms were anaerobes or facultative anaerobes. The most common organisms identified were Streptococcus and Staphylococcus species. Actinomyces and Propionibacterium species followed. Actinomyces israelii was not cultured. Eighteen patients responded to a mailed survey (response rate, 67%). Most respondents (83%) denied having either epiphora or mattering at median 90 months follow-up. Three of the respondents reported having had an additional episode of canaliculitis since last clinical follow-up. Two of these occurred in a previously uninvolved punctum. CONCLUSIONS Although involvement of multiple canaliculi over time is more common than previously recognized, most patients do not have lingering problems with epiphora or mattering. The microbiology of primary canaliculitis does not appear to be evolving, with Actinomyces, and other anaerobes or facultative anaerobes being common pathogens.