Evaluation of Ultrasound Biomicroscopy Combined with Color Doppler Flow Imaging in the Diagnosis of Primary Lacrimal Canaliculitis

Lacrimal Canaliculitis: A Major Review

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.

Anterior Segment Optical Coherence Tomography for Canaliculitis

Canaliculitis is an uncommon inflammation of the lacrimal canaliculi, and it is often misdiagnosed as conjunctivitis or dacryocystitis. There are no gold-standard methods to diagnose canaliculitis, therefore newer methods such as ulrasound biomicroscopy are being introduced. Anterior segment optical coherence tomography (OCT) is being utilized to evaluate punctum and canaliculus, but no previous study has applied anterior OCT for canaliculitis. One case of canaliculitis with canaliculith was diagnosed by anterior segment OCT noninvasively, by successful detection of canaliculith. Pouting of the punctum and detection of canaliculith as hyper-reflective signals by OCT were checked, which was impossible with other conventional methods. Surgical incision and drainage confirmed the presence of stones. This article is meaningful as a first study about the diagnosis of canaliculitis with canaliculith using anterior segment OCT. Presence of canaliculith in vertical canaliculus, and the status of punctal epithelium and canalicular mucosa was possible in this study.

[Punctal stenosis: etiology, diagnosis, treatment]

This article reviews etiological factors in the development of lacrimal punctal stenosis, modern diagnostic techniques, as well as both conservative and surgical treatment methods. The presented analysis is based on data from 67 literary sources, which provide information on conventional and high-tech examination and treatment methods of patients with lacrimal punctal stenosis. Particular attention is paid to various aspects of punctoplasty - the most common surgical intervention used to treat this pathology.