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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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Metagenomic Shotgun Sequencing Analysis of Canalicular Concretions in Lacrimal Canaliculitis Cases. Curr Issues Mol Biol 2021; 43:676-686. [PMID: 34287258 PMCID: PMC8928969 DOI: 10.3390/cimb43020049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
Lacrimal canaliculitis is a rare infection of the lacrimal canaliculi with canalicular concretions formed by aggregation of organisms. Metagenomic shotgun sequencing analysis using next-generation sequencing has been used to detect pathogens directly from clinical samples. Using this technology, we report cases of successful pathogen detection of canalicular concretions in lacrimal canaliculitis cases. We investigated patients with primary lacrimal canaliculitis examined in the eye clinics of four hospitals from February 2015 to July 2017. Eighteen canalicular concretion specimens collected from 18 eyes of 17 patients were analyzed by shotgun metagenomics sequencing using the MiSeq platform (Illumina). Taxonomic classification was performed using the GenBank NT database. The canalicular concretion diversity was characterized using the Shannon diversity index. This study included 18 eyes (17 patients, 77.1 ± 6.1 years): 82.4% were women with lacrimal canaliculitis; canalicular concretions were obtained from 12 eyes using lacrimal endoscopy and six eyes using canaliculotomy with curettage. Sequencing analysis detected bacteria in all samples (Shannon diversity index, 0.05–1.47). The following genera of anaerobic bacteria (>1% abundance) were identified: Actinomyces spp. in 15 eyes, Propionibacterium spp., Parvimonas spp. in 11 eyes, Prevotella spp. in 9 eyes, Fusobacterium spp. in 6 eyes, Selenomonas spp. in 5 eyes, Aggregatibacter spp. in 3 eyes, facultative and aerobic bacteria such as Streptococcus spp. in 13 eyes, Campylobacter spp. in 6 eyes, and Haemophilus spp. in 3 eyes. The most common combinations were Actinomyces spp. and Streptococcus spp. and Parvinomonas spp. and Streptococcus spp., found in 10 cases. Pathogens were identified successfully using metagenomic shotgun sequencing analysis in patients with canalicular concretions. Canalicular concretions are polymicrobial with anaerobic and facultative, aerobic bacteria.
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Landman-Vu J, Fayet B, Racy E, Hanna NG, Merle H. Primary Lacrimal Canaliculitis with clinically detected concretions: One-snip punctoplasty with lateral canaliculotomy vs. punctum sparing canalicular curettage. J Fr Ophtalmol 2021; 44:855-862. [PMID: 34020811 DOI: 10.1016/j.jfo.2020.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare two distinct surgical techniques in the management of chronic Primary Lacrimal Canaliculitis (PLC) with clinically detectable concretions. MATERIALS AND METHODS Inclusion criteria: Patients presenting with symptoms consistent with the diagnosis of primary lacrimal canaliculitis (PLC) with ocular involvement were gathered. Gomori-Grocott Methenamine Silver test was used for concretion staining. Two groups were identified based on the surgical technique. Group A consisted of patients who underwent a punctum sparing canalicular curettage using a chalazion curette, while the patients in Group B underwent one-snip punctoplasty with lateral canaliculotomy. Failure was defined as recurrence of the initial symptoms at any time (ocular and canalicular inflammation with purulent discharge and pouting punctum). The results were analyzed by comparisons using a Fisher's exact test. RESULTS Ninety-six consecutive patients (96) with a confirmed diagnosis of PLC underwent surgical treatment between 1987 and 2017. Data were collected and divided based on the surgical technique discussed above (Group A and B). Group A: 51 cases with a mean follow-up time of 22 months [1-224] presented with a mean age of 51.5 [25-83] and a surgical failure rate of 19.6%. Group B: 45 patients with a mean follow-up time of 27 months [1-176], a mean age of 68 [17-87] years and a surgical failure rate of 4.4%. Statistical significance was demonstrated, with a p-value of 0.033, odds ratio (OR) of 0.1936 and Standard Deviation (SD) at a 95% confidence interval of [0.0195-0.9885]. CONCLUSIONS One-snip punctoplasty with lateral canaliculotomy is a simple, fast and effective procedure that allows better anatomical visualization intraoperatively and is thus shown to be statistically superior to punctum sparing canalicular curettage using a chalazion curette.
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Affiliation(s)
- J Landman-Vu
- OphtalmoPôle, Hôpital Cochin, 27, rue du Faubourg Saint Jacques, 75014 Paris, France.
| | - B Fayet
- OphtalmoPôle, Hôpital Cochin, 27, rue du Faubourg Saint Jacques, 75014 Paris, France
| | - E Racy
- ENT, Fondation Saint Jean de Dieu, 2, rue Rousselet, 75007 Paris, France
| | - N-G Hanna
- OphtalmoPôle, Hôpital Cochin, 27, rue du Faubourg Saint Jacques, 75014 Paris, France
| | - H Merle
- CHU Pierre Zobda Quitman, CS 90632, Fort de France Cedex, France
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Yartsev VD, At Kova EL. [Formation of concrements in the lacrimal excretory system]. Vestn Oftalmol 2020; 136:78-83. [PMID: 33084283 DOI: 10.17116/oftalma202013606178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Studying the pathogenesis of concrements formation in lacrimal ducts is of fundamental and practical importance. This article attempts to analyze available information related to the pathogenesis of this phenomenon, provides information on the etiopathogenesis, physical and chemical properties of concrements obtained from horizontal and vertical parts of the lacrimal duct, and considers in detail bacteriological and mycotic composition of concrements, as well as various theories of their formation. The analysis helped justify the need to separate the concrements formed in the horizontal and vertical parts of the lacrimal ducts on the basis of differences in their pathogenesis. Actinomycotic infection is the cause of concrements formation in the horizontal part of the lacrimal duct in the overwhelming majority of cases. The process of concrements formation in the vertical part of the lacrimal duct in some cases occurs as a result of previous clinical events, but in many other cases the trigger mechanisms remain unknown. To date, the role of the initial narrowing of the lacrimal ducts in the pathogenesis of concrements is not clearly defined. The accumulated knowledge regarding the pathogenesis of concrements is currently not enough to formulate a complete theory of the development of this phenomenon. Further studies of the pathogenesis of concrements will help develop new diagnostic and therapeutic measures aimed at restoring the patency of the lacrimal ducts.
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Affiliation(s)
- V D Yartsev
- Research Institute of Eye Diseases, Moscow, Russia
| | - E L At Kova
- Research Institute of Eye Diseases, Moscow, Russia
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Su Y, Zhang L, Li L, Fan X, Xiao C. Surgical procedure of canaliculoplasty in the treatment of primary canaliculitis associated with canalicular dilatation. BMC Ophthalmol 2020; 20:245. [PMID: 32563241 PMCID: PMC7305593 DOI: 10.1186/s12886-020-01503-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Primary canaliculitis is a chronic infection of the proximal lacrimal pathway. We aimed to evaluate surgical outcomes of a canaliculoplasty procedure for primary canaliculitis associated with canalicular dilatation. Methods This study enrolled 42 primary canaliculitis patients with canalicular dilatation who underwent canaliculoplasty. All patients were treated with canaliculotomy, curettage of canalicular contents and canaliculoplasty with stent placement. Patients’ demographics, clinical features, and follow-up outcomes were evaluated. Results There were 12 males and 30 females with a mean age of 66.1 ± 13.9 years. The mean duration time from the first onset of signs/symptoms to diagnosis was 30.6 ± 39.5 months. Epiphora (90.5%) and mucopurulent discharge from punctum (85.7%) were the most common signs. Thirty-three out of 42 patients (78.6%) achieved complete remission with a mean follow-up time of 25.3 ± 12.9 months. There were 3 patients found to have canalicular stenosis due to obstruction after surgery. Conclusion Canalicular dilatation is a severe condition of primary canaliculitis, probably due to a combined result of long standing disease and the presence of concretions. The surgical procedure of canaliculoplasty can be a highly effective treatment for primary canaliculitis associated with canalicular dilatation.
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Affiliation(s)
- Yun Su
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Leilei Zhang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Lunhao Li
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China. .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
| | - Caiwen Xiao
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China. .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
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Eraslan Yusufoğlu E, Güngör Kobat S. Pediatric Canaliculitis: A Case Report. Turk J Ophthalmol 2019; 49:102-105. [PMID: 31055896 PMCID: PMC6517850 DOI: 10.4274/tjo.galenos.2018.04453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Canaliculitis is a rare disease that relapses when not properly diagnosed and treated. It usually occurs in middle-age and advanced age. It is extremely rare in children and infants. A healthy 12-year-old girl presented with lower eyelid swelling and watery discharge in her right eye. During the last 2 years, the patient had been examined several times for the same complaints but there was no improvement despite treatment. Examination showed that the lower punctum had a pouting punctum appearance, and applying pressure to the lacrimal sac area resulted in purulent discharge. Lavage showed that the lacrimal passage was patent. In light of these clinical findings, the patient was diagnosed with canaliculitis. Punctoplasty with surgical curettage of the dacryoliths were performed. After the surgical procedure, a topical antibiotic was prescribed. Histopathological examination of the dacryoliths revealed that the infective cause was Actinomyces. No recurrence or complications were observed during 12 months follow-up.
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