Bacterial midrib rot, caused by Pseudomonas cichorii, has become a serious threat to the production of greenhouse butterhead lettuce (Lactuca sativa L. var. capitata) in Belgium. Currently, there are no strategies for controlling this pathogen. Therefore, greenhouse experiments were conducted to obtain more knowledge about the epidemiology of P. cichorii on butterhead lettuce. Greenhouse butterhead lettuce becomes susceptible to lettuce midrib rot infections at head formation, and a single overhead irrigation with water containing 102 CFU/ml P. cichorii was sufficient to cause disease. The use of surface drip irrigation instead of overhead sprinkler irrigation significantly reduced midrib rot incidence in the greenhouse. P. cichorii isolates can be divided into subgroups based on BOX-PCR genomic fingerprinting, with isolates belonging to subgroup C1 and C2 being more virulent than those of (or related to) subgroup C3. P. cichorii infections with distinct symptoms comparable to midrib rot have also been observed on field-grown crisphead lettuce in California and Japan which, respectively, are referred to as `varnish spot' or `tar'. We showed that symptom expression is strongly influenced by the lettuce cultivar group, irrespective of the P. cichorii isolate, resulting in varnish spot/tar on crisphead lettuce and midrib rot on butterhead or cutting group lettuce.