lacrimal canaliculitis is a rare disease caused mainly by actinomyces israelii. it should be regarded as a differential diagnosis of recurrent chronic conjunctivitis. the purpose of this study was to report 3 cases of chronic suppurative canaliculitis and different treatment options. the first patient presented with an upper left canaliculitis and was treated with a canaliculotomy. nevertheless, he had an ipsilateral lower canaliculitis after 6 months and underwent intracanalicular injections of fortified cefazolin with complete remission. the second patient presented with a lower left canaliculitis and underwent a canaliculotomy. the third patient had a lower left canaliculitis and underwent intracanalicular injections of fortified cefazolin. both achieved complete remission. the present article demonstrated that intracanalicular irrigation of fortified cefazolin may be a helpful treatment of chronic suppurative canaliculitis with mild symptoms and signs. the most important benefit of this approach is to avoid injury to the lacrimal canaliculus.