Canaliculitis Awareness

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.

Microbiological isolates and associated complications of dacryocystitis and canaliculitis in a prominent tertiary ophthalmic teaching hospital in northern China

BACKGROUND

To report the microbiological isolates, aetiology, complications, antibiotic susceptibilities, and clinical remission of dacryocystitis and canaliculitis in a prominent tertiary ophthalmic teaching and referral hospital located in northern China and to offer appropriate recommendations for preventing and formulating drug treatment strategies.

METHODS

This prospective study recruited a total of 477 participants who had been diagnosed with either dacryocystitis or canaliculitis. The cohort comprised 307 patients with chronic dacryocystitis, 111 patients with acute dacryocystitis, and 59 patients with canaliculitis. Purulent discharge from the lacrimal duct was collected using a sterile swab and immediately subjected to microbial culture. Antimicrobial susceptibility testing was conducted following established protocols. All participants were scheduled for follow-up visits within 14 days after receiving antibiotic therapy.

RESULTS

The present findings indicated that women exhibited a higher susceptibility to the condition, as evidenced by the occurrence of 367 cases in comparison to 110 cases among men. Among the 477 patients, definitive causes were established in 59 individuals, accounting for 12.4% of the patients. Additionally, ocular complications were reported by 132 patients, representing 27.7% of the total. Monocular involvement was observed in the majority of cases, with 402 out of 477 patients (84.3%) affected, while binocular involvement was present in 75 patients (15.7%). In total, 506 microbiological strains were recovered from 552 eyes, with Staphylococcus epidermidis (16.4%) being the most prevalent microorganism. Other predominant isolates included Corynebacterium macginleyi (9.1%), Staphylococcus aureus (5.1%), Streptococcus pneumoniae (4.9%), Haemophilus (4.4%), Propionibacterium acnes (3.5%), and Eikenella corrodens (3.1%). Among the 12 isolated fungi, Candida parapsilosis accounted for 66.7%. The susceptibility to antimicrobial agents tested in gram-negative bacilli (79.5%) was observed to be higher than that of anaerobic bacteria (76.7%) and gram-positive cocci (55.4%). With pharmacological therapy, the remission rate of acute dacryocystitis (72.7%) was found to be higher than that of canaliculitis (53.3%) and chronic dacryocystitis (42.3%).

CONCLUSIONS

This study highlights the microbial spectrum of dacryocystitis and canaliculitis, particularly C.macginleyi, E.corrodens and C.parapsilosis, which are also more frequently isolated. Vancomycin and imipenem may be more effective treatment options. Most cases have an unknown aetiology, and essential preventive measures involve postoperative cleansing of the lacrimal passage following eye and nasal surgeries, as well as the proactive management of rhinitis.

Actinomycotic primary canaliculitis: Predisposing factors, clinical characteristics, and treatment outcomes

OBJECTIVE

Ocular actinomycosis is an uncommon progressive infection. The study aims to investigate the predisposing factors, clinical characteristics and treatment outcomes of culture-proven cases of Actinomycotic primary canaliculitis.

METHODS

Single-center, retrospective, interventional case series. Culture-proven cases of Actinomyces-associated primary canaliculitis diagnosed and treated between January 2017 and December 2021 at the Beijing Tongren Eye Center, Capital Medical University were identified and reviewed for ocular and systemic risk factors, clinical presentations, microbiological profile, treatment modalities and outcomes.

RESULTS

Of the 201 patients diagnosed with primary canaliculitis, 22 (10.9%) were caused by Actinomyces. The mean age at onset of 22 patients (21 women and one men) was 54 years. The lower canaliculus was most commonly involved (54.6%). The most frequent symptom was mattering without epiphora (77.3%) and clinical signs were punctal regurgitation of purulent discharge (100%) and expressible concretions (95.5%). Dry eye co-existed in 77.3% of patients, whereas no obvious systemic factors were found. Among 19 cases (86.0%) of identified Actinomyces species, A. odontolyticus (43.5%) was the predominant causative microorganism. There were 50% of patients with polymicrobial infection and the most common additional bacteria isolated were Streptococcus species. Conservative therapy combining repeated canalicular expression and irrigation with susceptible topical antibiotics achieved complete resolution in 86.4% of patients.

CONCLUSIONS

Dry eye was identified in the vast majority of patients with Actinomycotic canaliculitis. Most cases are odontogenic in origin and the infection occurs in immunocompetent individuals. The conservative method combining canalicular expression and irrigation with topical susceptible antibiotics is recommendable as initial therapy.

A prospective study comparing mini-invasive and conventional canaliculotomy of punctum-sparing canaliculotomy for primary canaliculitis treatment

PURPOSE

To compare outcomes of mini-invasive canaliculotomy with those of conventional canaliculotomy conducted using the punctum-sparing approach for the treatment of primary canaliculitis.

METHODS

A prospective, comparative, and interventional case series study was conducted on 118 individuals with unilateral inferior primary canaliculitis. These patients were randomly divided into two groups, each with 59 cases. Group A underwent mini-invasive canaliculotomy (minor incision ~3 mm), whereas group B received conventional canaliculotomy (long incision ~6-8 mm). Punctum-sparing and canaliculus-reconstructing procedure was used to treat all patients. Both groups had silicone tube intubations and were retained in the lacrimal passages for one month. Both groups' surgical success rates and postoperative complications were measured at the last follow-up of 12 months after surgery.

RESULTS

A total of 108 patients were finally included in the study, 53 in group A and 55 in group B. There were 79 females and 29 males with a median age of 57 ± 13.4 years. The anatomical success rates for groups A and B were 96.2% and 92.7% (P = 0.679), respectively. Functional success rate was accomplished by considerably more patients in group A (50/53, 94.3%) compared to group B (45/55, 81.8%) (P = 0.046). No recurrences were seen during follow-up visits in any of the participants.

CONCLUSIONS

The two procedures employed in this study to treat primary canaliculitis achieves excellent clinical effects with no incidence of recurrence. The mini-invasive canaliculotomy is worthy to be recommended for its higher functional success rate with mini-invasion of canaliculus and intact lacrimal punctum.

Corneal Perforation Associated with Lacrimal Canaliculitis: A Case Series

Purpose

To report seven eyes of six patients diagnosed with corneal perforation and lacrimal canaliculitis in a single facility.

Methods

Clinical records of patients with corneal perforation accompanied by lacrimal canaliculitis seen by the authors were reviewed.

Results

Six patients (7 eyes) with corneal perforation accompanied by lacrimal canaliculitis were identified. All patients were female, and all were treated with topical antibiotics while five were receiving topical corticosteroids. Two patients had a history of dacryocystitis and three had systemic immune diseases. The corneal lesions did not respond to topical antibiotics but were effectively treated by removal of concretions in the lacrimal canaliculi and lacrimal duct drainage together with conjunctival autograft or corneal transplantation.

Conclusion

Lacrimal canaliculitis is a risk factor for corneal perforation. When corneal perforation does not respond to antibiotics, lacrimal canaliculitis should be considered.

A "Clinical Tetrad" for Easy Diagnosis of Lacrimal Canaliculitis

Purpose

To study the clinical presentation and highlight the "diagnostic clinical features" in patients having lacrimal canaliculitis (LC).

Methods

A retrospective analysis of all patients diagnosed with primary and secondary LC was performed. A detailed slit-lamp examination of the conjunctiva, lacrimal punctum, canalicular region, and lacrimal sac was performed. Common and coexisting clinical features were highlighted. The posttreatment sequence of resolution of clinical features was also noted.

Results

Forty eyes of 36 patients (28 females, 77.78%) with a mean age of 59.5 years were included in the study. Thirty eyes (75%) had primary LC, whereas 10 had a secondary type. Previous misdiagnoses were noted in 34 (85%) eyes. The highlighting clinical features were medial eyelid edema (n = 40, 100%), pouting and hyperemia of lacrimal punctum (n = 36, 90%), yellowish canalicular hue (n = 35, 87.5%), and canalicular distention and expressible discharge (n = 32, 80%). None had features suggestive of nasolacrimal duct obstruction. Thirty-two eyes (80%) showed all four clinical features of LC, a tetrad. At a mean follow-up of 14.5 months, the complete resolution was noted in 36 (90%) eyes.

Conclusions

We propose a "clinical tetrad" of 1. medial eyelid edema, 2. pouting and hyperemia of lacrimal punctum, 3. yellowish canalicular hue and, 4. canalicular distention, and expressible discharge, for the easier clinical diagnosis of LC. The authors believe that using this clinical tetrad may be helpful for the diagnosis of LC.

Outcomes of Canaliculotomy with and without Silicone Tube Intubation in Management of Primary Canaliculitis

PURPOSE

To compare the outcomes of canaliculotomy and curettage with and without silicone tube intubation in the treatment of primary canaliculitis.

METHODS

A prospective, randomized, interventional case series was performed. Fifty patients diagnosed with unilateral inferior primary canaliculitis underwent canaliculotomy with curettage and were randomly divided into two groups depending on silicone tube intubation. Twenty-five patients were recruited in group A (without intubation) and 25 patients were recruited in group B (with intubation). The resolution of infection, the success rate and postoperative complications observed in both groups were analyzed with a minimum follow-up of 1 year.

RESULTS

Forty-seven patients were finally included in the study consisting of 23 patients in group A and 24 patients in group B. There were 33 females and 14 males with a median age of 57 ± 13.9 years (range 29-89 years). All patients recorded complete resolution of canaliculitis and no recurrent infections were observed in the 2 groups during follow-up. A significantly higher number of anatomical and functional successes were achieved in patients in group B (100%, 87.5%) than in group A (78.3%, 60.9%) (P < .05,). The surgical complication of canalicular obstruction was significantly higher in patients in group A (21.7%, 5/23) compared to group B (0/24)(P < .05).

CONCLUSION

Canaliculotomy with curettage gives excellent clinical outcomes in the treatment of patients with primary canaliculitis and a higher success rate can be achieved when silicone tube intubation is performed during the procedure. The use of silicone tube intubation may be a necessary choice in canaliculotomy to avoid post-operative canalicular obstruction.

Pediatric Canaliculitis: A Case Report

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.

Outcomes of canaliculotomy in recalcitrant canaliculitis

Purpose

To evaluate outcomes of canaliculotomy in cases of recalcitrant canaliculitis.

Methods

All cases diagnosed with canaliculitis who subsequently underwent canaliculotomy over a 15 year period were included in the study. We reviewed and analyzed demographic data, clinical presentation, microbiological profile and management outcomes.

Results

Out of 40 patients, 21 (52.5%) were males. Age range was 17–89 years. Lower canaliculus was affected most commonly (53.81%). Mean duration of symptoms was 8 months (range- 0.5–60 months, median 6 months). The most common presenting symptom was watering (34, 85%) while pouting puncta (32, 80%) was the most frequently documented clinical sign. Concretions were seen in 20 (50%) patients and Actinomyces was the most commonly isolated micro organism in the concretion group. Polymicrobial growth was seen in 18 (45%) patients. Commonly isolated bacteria on culture were Staphylococcus epidermidis (16, 40%) followed by Actinomyces (14, 34%) and Corynebacterium species (5, 12.5%). Complete resolution was seen in 39 cases post-operatively (97.5%, p = 0.0002). Mean follow up period was 21 months (range- 3–180 months).

Recurrence was noted in 6(15%) cases, of which 4 were males (66.67%, p = 0.069) Four (66.67%, p = 0.069) patients had associated diabetes and 5 (83.33%, p = 0.046) had associated concretions. Six (15%) patients complained of persistent epiphora.

Conclusion

Canaliculotomy is a safe and effective method for management of recalcitrant canaliculitis with a success rate of 85%. Presence of concretions was associated with higher risk of recurrence in our study.