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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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Tamimi A, Sheikhzadeh F, Ezabadi SG, Islampanah M, Parhiz P, Fathabadi A, Poudineh M, Khanjani Z, Pourmontaseri H, Orandi S, Mehrabani R, Rahmanian M, Deravi N. Post-LASIK dry eye disease: A comprehensive review of management and current treatment options. Front Med (Lausanne) 2023; 10:1057685. [PMID: 37113611 PMCID: PMC10126282 DOI: 10.3389/fmed.2023.1057685] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/14/2023] [Indexed: 04/29/2023] Open
Abstract
Laser-assisted in situ keratomileusis (LASIK) is a unique corneal stromal laser ablation method that uses an excimer laser to reach beneath corneal dome-shaped tissues. In contrast, surface ablation methods, such as photorefractive keratectomy, include removing epithelium and cutting off the Bowman's layer and the stromal tissue of the anterior corneal surface. Dry eye disease (DED) is the most common complication after LASIK. DED is a typical multi-factor disorder of the tear function and ocular surface that occurs when the eyes fail to produce efficient or adequate volumes of tears to moisturize the eyes. DED influences quality of life and visual perception, as symptoms often interfere with daily activities such as reading, writing, or using video display monitors. Generally, DED brings about discomfort, symptoms of visual disturbance, focal or global tear film instability with possible harm to the ocular surface, the increased osmolarity of the tear film, and subacute inflammation of the ocular surface. Almost all patients develop a degree of dryness in the postoperative period. Detection of preoperative DED and committed examination and treatment in the preoperative period, and continuing treatments postoperatively lead to rapid healing, fewer complications, and improved visual outcomes. To improve patient comfort and surgical outcomes, early treatment is required. Therefore, in this study, we aim to comprehensively review studies on the management and current treatment options for post-LASIK DED.
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Affiliation(s)
- Atena Tamimi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sajjad Ghane Ezabadi
- Students’ Scientific Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Peyman Parhiz
- Student Research Committee, Zahedan Medical Sciences Branch, Islamic Azad University, Zahedan, Iran
| | - Amirhossein Fathabadi
- Student Research Committee, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Zahra Khanjani
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Pourmontaseri
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
- Bitab Knowledge Enterprise, Fasa University of Medical Sciences, Fasa, Iran
| | - Shirin Orandi
- Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Mehrabani
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad Rahmanian
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- *Correspondence: Niloofar Deravi,
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Abstract
Punctal plugs are an effective treatment option for patients with aqueous-deficient dry eye refractory to topical medications. However, punctal plugs are not commonly used in clinical practice mainly because of various misconceptions, rather than clinical complications. We analyzed previous studies and present 5 misconceptions related to punctal plugs. The first and most important misconception is that ocular surface inflammation should be sufficiently controlled before punctal plug insertion. However, it is unclear how ocular surface inflammation can be sufficiently controlled in patients refractory to conventional topical medications. The second misconception is that silicone punctal plugs are made of nonabsorbable materials and, therefore, permanent. In fact, silicone plugs are reversible and can be easily removed if necessary. Therefore, depending on the specific type, nonabsorbable plugs may be classified as reversible or permanent. The third misconception is that punctal plugs disrupt normal tear drainage. However, punctal plugs maintain natural tears on the ocular surface for extended periods and reduce the frequency of artificial tear use. The fourth is that all punctal and canalicular plugs have similar effects. The efficacy and complication rates differ depending on plug types. The fifth misconception about punctal plugs is that they are effective only in aqueous-deficient dry eye disease. Many studies have reported that plugs are effective in a variety of ocular diseases and conditions. Understanding these 5 misconceptions may provide an opportunity to rethink the use of silicone punctal plugs in clinical practice.
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Jin X, Fan F, Zhang F, Zhao Y, Hu R. A treatment method for chronic suppurative lacrimal canaliculitis using chalazion forceps. Indian J Ophthalmol 2017; 64:589-92. [PMID: 27688281 PMCID: PMC5056547 DOI: 10.4103/0301-4738.191506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose: The purpose of this study is to evaluate the effectiveness of chronic suppurative lacrimal canaliculitis treatment using chalazion forceps. Patients and Methods: A prospective study was performed on consecutive patients who accepted the aid of chalazion forceps to treat chronic suppurative lacrimal canaliculitis. Two different treatment methods using chalazion forceps were performed according to the degree of lacrimal canaliculitis. Postoperatively, the patients received 0.5% levofloxacin eye drops four times per day and 0.5 g oral levofloxacin tablets once per day for 4 days. The follow-up period was more than 3 months. Lacrimal irrigation, the condition of the lacrimal punctum, and patients’ symptoms were carefully evaluated. Results: In total, 32 patients met the criteria for chronic suppurative lacrimal canaliculitis. Included were 6 males and 26 females. Their average age was 51.7 ± 14.9 years (range; 19–80 years), and all had unilateral canaliculitis. The mean duration of the symptoms was 18.9 ± 9.8 months (range; 3–48 months). The mean follow-up time was 14.7 ± 7.8 months. The signs and symptoms resolved completely in all patients within 15 days, and no recurrence was observed. No patients reported epiphora after the treatment. Conclusions: The use of chalazion forceps is effective in treating chronic suppurative lacrimal canaliculitis. The forceps may offer an alternative treatment technology in the management of suppurative lacrimal canaliculitis.
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Affiliation(s)
- Xiuming Jin
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Fangli Fan
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Fan Zhang
- Zhejiang University School of Medicine, Hangzhou, China
| | - Yingying Zhao
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Renjian Hu
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Jones L, Downie LE, Korb D, Benitez-del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf 2017; 15:575-628. [DOI: 10.1016/j.jtos.2017.05.006] [Citation(s) in RCA: 578] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023]
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Balıkoğlu Yılmaz M, Şen E, Evren E, Elgin U, Yılmazbaş P. Canaliculitis Awareness. Turk J Ophthalmol 2016; 46:25-29. [PMID: 27800254 PMCID: PMC5076306 DOI: 10.4274/tjo.68916] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/07/2015] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate the demographic characteristics, treatment, and results of patients with canaliculitis. Materials and Methods: Medical records including the demographic characteristics, clinical findings, and treatment outcomes of patients diagnosed and treated for canaliculitis between September 2009 and March 2014 were analyzed retrospectively. Results: The median age of the 7 canaliculitis patients consisting of 4 women and 3 men was 49 (range 8-58) years. All patients had unilateral canaliculitis (on the right side in 2 and left side in 5 patients) and the inferior canaliculus was involved more frequently (71.4%). Epiphora, chronic conjunctivitis, a palpable and thickened canaliculus, and yellow discharge from the punctum were present in all cases. Actinomyces spp. was the most frequently cultured microorganism (75%). Dacryolith was observed in 6 patients. Canaliculotomy and dacryolith removal with canalicular curettage were performed, followed by medical treatment (topical penicillin 100,000 U/ml and oral ampicillin/sulbactam) for 10 days. Patients were followed up for a mean duration of 17.0±15.2 (range 3-46) months. Signs and symptoms resolved completely within a month. Epiphora recurred in the 36th month in a single patient and was treated with daily canalicular irrigation with antibiotics and there were no further symptoms during 10 months of follow-up after the recurrence. Conclusion: Canaliculitis is often overlooked and can be misdiagnosed. Every patient with chronic conjunctivitis and lacrimal infection should be examined carefully for canaliculitis.
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Affiliation(s)
- Melike Balıkoğlu Yılmaz
- Dr. Behçet Uz Children's Disease and Surgery Education and Research Hospital, Ophthalmology Clinic, İzmir, Turkey
| | - Emine Şen
- Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Ebru Evren
- Başkent University Faculty of Medicine, Department of Microbiology, Ankara, Turkey
| | - Ufuk Elgin
- Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Pelin Yılmazbaş
- Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
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Klein-Theyer A, Boldin I, Rabensteiner DF, Aminfar H, Horwath-Winter J. Prevalence of canaliculitis after smartplug insertion during long-term follow-up. Br J Ophthalmol 2015; 99:1134-6. [DOI: 10.1136/bjophthalmol-2014-306290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 02/03/2015] [Indexed: 11/04/2022]
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Abstract
PURPOSE To assess the effectiveness of the Crawford tube for the treatment of chronic suppurative lacrimal canaliculitis. METHODS A prospective study was performed on 8 consecutive patients who accepted the Crawford tube to treat chronic suppurative lacrimal canaliculitis. Postoperatively, the patients were treated with 0.5% levofloxacin eyedrops 4 times per day and oral levofloxacin tablets 0.5 g once per day for 4 days. Follow-up times were >3 months after removing the Crawford tube. The condition of the lacrimal punctum and patient's symptoms were carefully evaluated. RESULTS All patients had unilateral single canaliculus involvement and had excellent resolution of canaliculitis without the need for surgical treatment. Complications included lacrimal punctum granulation and lacrimal punctum dehiscence. CONCLUSIONS The insertion of the Crawford tube may offer an alternative to surgery in the management of suppurative lacrimal canaliculitis.
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Abstract
Canaliculitis is an uncommon, often misdiagnosed diagnosis because canaliculitis can mimic many other common ocular conditions. Canaliculitis should be appropriately diagnosed and treated to avoid recurrent inflammation and possible obstruction of the upper portion of the lacrimal system. This review will serve as a concise resource to aid in diagnosis and provide updated management options.
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Tong L, Zhao Y, Lee R. Corneal refractive surgery-related dry eye: risk factors and management. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2013.851602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rabensteiner DF, Boldin I, Klein A, Horwath-Winter J. Collared Silicone Punctal Plugs Compared to Intracanalicular Plugs for the Treatment of Dry Eye. Curr Eye Res 2013; 38:521-5. [DOI: 10.3109/02713683.2013.765487] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Punctal and canalicular plugs are widely used for both temporary and permanent occlusion of the lacrimal puncta in dry eyes. There are many designs and materials available on the market. While their efficacy in improving dry eye symptoms is widely proven, the gamut of complications associated with these devices have never been subject to a general review, although there are numerous case series in the literature associated with one particular device. This review aims to examine the track record of a variety of plugs currently in use, to review the management of complications, and propose strategies for both the prevention of these complications and their treatment.
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Affiliation(s)
- Rabia Bourkiza
- Ophthalmology Department, Central Middlesex Hospital, Middlesex, London, UK
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13
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Punctal plugs for treatment of post-LASIK dry eye. Jpn J Ophthalmol 2012; 56:208-13. [DOI: 10.1007/s10384-012-0125-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 11/16/2011] [Indexed: 10/28/2022]
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14
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Freedman JR, Markert MS, Cohen AJ. Primary and Secondary Lacrimal Canaliculitis: A Review of Literature. Surv Ophthalmol 2011; 56:336-47. [DOI: 10.1016/j.survophthal.2010.12.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 12/01/2010] [Accepted: 12/07/2010] [Indexed: 11/29/2022]
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Clinical efficacy of the smartplug™ in the treatment of primary Sjogren’s syndrome with keratoconjunctivitis SICCA: one-year follow-up study. Rheumatol Int 2010; 31:1567-70. [DOI: 10.1007/s00296-010-1527-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 05/02/2010] [Indexed: 10/19/2022]
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17
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Lee MJ, Lee KW, Kim NJ, Choung HK, Khwarg SI. Canaliculitis Associated With SmartPlug™ Punctal Plug Insertion: Clinical Features and Management. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.6.821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Min Joung Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Kyeong Wook Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Nam Ju Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul, Korea
| | - Ho-Kyung Choung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
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Ahn SM, Kim HC, Jang JW, Kim SJ. Treatment of the SmartPLUG-related Canaliculitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.12.1768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sung Min Ahn
- Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Korea
| | - Ho Chang Kim
- Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Korea
| | - Jea Woo Jang
- Myung Gok Eye Reserch Institute, Kim's Eye Hospital, Konyang University, Seoul, Korea
| | - Sung Joo Kim
- Myung Gok Eye Reserch Institute, Kim's Eye Hospital, Konyang University, Seoul, Korea
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Bibliography. Current world literature. Corneal and external disorders. Curr Opin Ophthalmol 2008; 19:363-6. [PMID: 18545022 DOI: 10.1097/icu.0b013e328308161d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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