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Pal SS, Alam MS. Lacrimal Canaliculitis: A Major Review. Semin Ophthalmol 2024:1-9. [PMID: 38762795 DOI: 10.1080/08820538.2024.2354689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
Lacrimal canaliculitis is an inflammation of the proximal lacrimal drainage system. It classically presents with symptoms of redness, mucopurulent discharge, medial canthal swelling, epiphora, and pouting punctum. Despite having classical clinical characteristics it is frequently misdiagnosed. The cause can be primarily due to various infectious agents or secondary mostly due to the use of punctal plugs. There are no universally accepted guidelines for the management of canaliculitis but different medical and surgical options have been employed with varying success rates and it is notorious for recurrences and failure to therapy. The present review summarizes the existing literature on lacrimal canaliculitis published over the past 15 years to provide an overview of this uncommon condition. A total of 100 articles published in the literature were anlaysed during this period. The mean age at diagnosis was 57.09 ± 16.91 years with a female preponderance. Misdiagnosis was common with many patients misdiagnosed as conjunctivitis and dacryocystitis. Primary canaliculitis was found to be more frequent than secondary with inferior canaliculus involved more commonly than the superior. Staphylococcus, Streptococcus, and Actinomyces were the most common microbes isolated. Surgical management was employed in 74.25% of cases while medical management was done in 20.82% of cases. The review presents an insight into the complexities of canaliculitis, its diagnosis, and management which will further help to improve the understanding of this uncommon infection of the lacrimal system.
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Affiliation(s)
- Soham S Pal
- Department of Ophthalmology, Dr. Vaishampayan Memorial Government, Medical College, Solapur, Maharashtra, India
| | - Md Shahid Alam
- Orbit, Oculoplasty, Reconstructive & Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, India
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Fulvio G, Izzetti R, Aringhieri G, Donati V, Ferro F, Gabbriellini G, Mosca M, Baldini C. UHFUS: A Valuable Tool in Evaluating Exocrine Gland Abnormalities in Sjögren's Disease. Diagnostics (Basel) 2023; 13:2771. [PMID: 37685309 PMCID: PMC10486364 DOI: 10.3390/diagnostics13172771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Sjögren's Disease (SjD) is a chronic autoimmune disorder that affects the salivary and lacrimal glands, leading to xerostomia and xerophthalmia. Ultrasonography of Major Salivary Glands (SGUS) is a well-established tool for the identification of the salivary glands' abnormalities in SjD. Recently, a growing interest has arisen in the assessment of the other exocrine glands with ultrasonography: lacrimal glands (LGUS) and labial salivary glands (LSGUS). The objective of this study is to explore the practical applications of ultra-high frequency ultrasound (UHFUS) in the assessment of lacrimal glands and labial salivary glands. Indeed, UHFUS, with its improved spatial resolution compared to conventional ultrasonography, allows for the evaluation of microscopic structures and has been successfully applied in various medical fields. In lacrimal glands, conventional high-frequency ultrasound (HFUS) can detect characteristic inflammatory changes, atrophic alterations, blood flow patterns, and neoplastic lesions associated with SjD. However, sometimes it is challenging to identify lacrimal glands characteristics, thus making UHFUS a promising tool. Regarding labial salivary glands, limited research is available with conventional HFUS, but UHFUS proves to be a good tool to evaluate glandular inhomogeneity and to guide labial salivary glands biopsy. The comprehensive understanding of organ involvement facilitated by UHFUS may significantly improve the management of SjD patients.
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Affiliation(s)
- Giovanni Fulvio
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Department of Clinical and Translational Science, University of Pisa, 56126 Pisa, Italy
| | - Rossana Izzetti
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giacomo Aringhieri
- Academic Radiology, Department of Clinical and Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Valentina Donati
- Unit of Pathological Anatomy 2, Department of Laboratory Medicine, University of Pisa, 56126 Pisa, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giovanna Gabbriellini
- Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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Wang Q, Sun S, Lu S, Hu R, Sun H, Gu Y, Zhang Z. Clinical diagnosis, treatment and microbiological profiles of primary canaliculitis. Exp Ther Med 2023; 25:157. [PMID: 36911369 PMCID: PMC9996171 DOI: 10.3892/etm.2023.11856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
The present study aimed to examine the clinical and pathogenic characteristics, diagnosis and treatment of primary canaliculitis to provide further guidance for its clinical management. The present prospective study enrolled 50 patients (50 eyes) diagnosed with primary canaliculitis between May 2018 and April 2021 at Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, China. The patients' general clinicopathological information, clinical characteristics, microbiological profiles and treatment outcomes were analyzed and summarized. All the patients presented with persistent red eyes and eye discharge. Examination of discharge smears revealed that 96% of patients tested positive for Actinomyces and all smears were negative for fungi. Microbial cultures indicated that 82% of cases were positive for bacteria. A total of 51 bacterial strains were cultured; of these, 27.5% were aerobes, 35.3% were anaerobes and 37.2% were facultative anaerobes. A total of 56.9% of strains were gram-positive and 43.1% were gram-negative. The three most common bacteria, including Streptococcus spp., Capnocytophaga spp. and Propionibacterium, were analyzed. Only 3 cases (6%) of microbial cultures were positive for Actinomyces and all cases were negative for fungi in microbial cultures. Among the 50 cases, 45 were cured with conservative treatment [intracanalicular ointment infiltration (IOI)]. Five patients responded poorly to conservative treatment; however, they were cured with surgical treatment. In the current study, the majority of canaliculitis cases were caused by mixed infections, predominantly Actinomyces. The results revealed that the culture positivity rate of Actinomyces was low; however, the smear staining positivity rate was high. Fungus was smear- and culture-negative in all cases. In conclusion, patients with canaliculitis had a good prognosis after timely diagnosis and treatment.
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Affiliation(s)
- Qinghua Wang
- Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, Jiangsu 214002, P.R. China.,Department of Ophthalmology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214002, P.R. China
| | - Song Sun
- Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, Jiangsu 214002, P.R. China.,Department of Ophthalmology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214002, P.R. China
| | - Shui Lu
- Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, Jiangsu 214002, P.R. China.,Department of Ophthalmology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214002, P.R. China
| | - Renjing Hu
- Department of Laboratory Medicine, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214002, P.R. China
| | - Hongjuan Sun
- Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, Jiangsu 214002, P.R. China.,Department of Ophthalmology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214002, P.R. China
| | - Yan Gu
- Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, Jiangsu 214002, P.R. China.,Department of Ophthalmology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214002, P.R. China
| | - Zhengwei Zhang
- Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, Jiangsu 214002, P.R. China.,Department of Ophthalmology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214002, P.R. China
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