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Chronic lacrimal canaliculitis is a rare infection of the lacrimal system, and can lead to misdiagnosis due to its overlapping presentation to other common entities. The authors report a case of lacrimal canaliculitis with a three-year history of recurrent unilateral red eye and mucopurulent discharge. Here, we describe the clinical course, surgica...
Citations
... Canaliculitis is a chronic infection of the canaliculus which accounts for 0.8% of all lacrimal drainage system infections. 1 The causes of canaliculitis are varied, including trauma, infection, foreign body, punctal plugs, and idiopathic. 2 Canaliculitis is usually unilateral and most commonly involves the inferior canaliculus. 3 At presentation, there is usually epiphora, swelling of the medial eyelid, erythema, pain, and discharge. Pouting of the punctum is considered a pathognomonic sign of canaliculitis, apart from swelling of the pars lacrimalis region, discharge, and focal conjunctival and eyelid erythema. ...
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.
... The presence of microorganisms in cases of dacryocystitis or canaliculitis poses a potential risk for the development of conjunctivitis, keratitis, or endophthalmitis [1]. However, in the field of ophthalmology, eye infections such as conjunctivitis and keratitis are commonly observed, while dacryocystitis and canaliculitis are regarded as less frequent ocular infections [2,3]. Therefore, there is a dearth of large-scale prospective microbiological studies and timely follow-up of drug therapeutic efficacy. ...
... However, 3 patients suffered severe complications within a month. It is noteworthy that although canaliculitis is a rare disease globally and in Asia [2,8], it accounted for 12.3% of cases in our study population, indicating a high incidence in this region. ...
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.
... 1,2 Its aetiology is predominantly infectious, with organisms such as Actinomyces Israelii being responsible for a significant proportion of cases. [3][4][5][6] Symptoms may include pericanalicular reddening and swelling, mucopurulent secretions and chronic unilateral conjunctivitis. ...
... Tear ducts may always appear unobstructed during irrigation probing, which complicates diagnosis. 2,6 Intraluminal concretions found in probing are highly specific to the disease and account for the metabolic behaviour of the microorganisms: they are composed of an internal tangle of mycelia fragments, sulphurous salts and a rosette of peripheral clubs, stabilized by a protein-polysaccharide complex, supposed to provide a resistance mechanism to host defences by inhibiting phagocytosis. 2,3,5,7 The first therapeutic step often includes antibiotic irrigation of the canalicula, which can be repeated upon recurrence of symptoms or inefficacy. ...
... However, the chances of resolution after medical therapy alone are low, making surgical canaliculotomy with curettage the gold standard treatment. 6 This condition's rarity and variable clinical presentation may lead to confusion with more prevalent ocular and orbital diseases such as chalazion, blepharitis, dacryocystitis or skin tumours. Palpebral rim skin tumours, in particular, may present similarly, with BCC being the most frequent followed by SCC. 8 In this challenging case, clinical examination alone was insufficient for an accurate diagnosis. ...
... Primary lacrimal canaliculitis is an uncommon, and often misdiagnosed unilateral inflammation of the lacrimal system [1]. It accounts for 2 -4% of the lacrimal pathologies, and mostly seen in the lower canaliculus [2][3][4]. The symptoms of the disease are similar to those seen in chronic conjunctivitis, dacryocystitis, chalazion, mucocele and blepharitis [5][6][7][8][9]. ...
... Primary canaliculitis usually occurs with no known cause [8]. It is mostly unilateral and affects the inferior canaliculus and more common seen women in menopause, as tear production and its protective effect against infections is reduced by hormonal changes [3,4,8,11,[14][15][16][17][18]. Multiple misdiagnosis are reported in various studies [9,11,[14][15][16]. ...
Citation: Titap Yazicioğlu and Şaban Şimşek. "Unilateral Inflammation of Proximal Lacrimal Drainage System". EC Ophthalmology 11.11 (2020): 40-44. Abstract Objective: To evaluate the efficacy of simple curettage in the treatment of persistent or recurrent canaliculitis patients which often misdiagnosed. Methods: The medical records of 5 patients with a history of canaliculitis-related symptoms for minimum 8 months and complaining about tenderness, recurrent epiphora with discharge, were reviewed retrospectively. All patients with clinically detectable canalicu-lar concretions were treated expressible drainage and simple curettage (without canaliculotomy). During the 9 months of follow-up period, no further symptoms was observed, and canaliculitis was totally resolved in all of the patients. Results: Five patients with a mean age of 52.2 ± 8.0 years (range, 45-65 years) were included in the study. Of the patients, 2 were women, and 3 were men. The mean duration of symptoms was 8.6 ± 2.2 months (range, 6-12) months. Epiphora, recurrent conjunctivitis , swelling around the canaliculus, and mucopurulent punctal discharge were present in all of the patients. Microbiological examination of the sample was reported as Streptomyces epidermidis. Conclusion: Canaliculitis is an uncommon, and often misdiagnosed inflammation of the lacrimal canalicular system. As it mimics many other common ocular conditions, there is usually a delay in the treatment. The patients with chronic conjunctivitis and lacrimal infection must be examined carefully for canaliculitis and can be easily treated with simple curettage and antibiotics.
... Se confirma el diagnóstico de canaliculitis aguda supurada, con concreciones del ojo izquierdo. (3,7,8) ...
... La canaliculitis puede ser mal diagnosticada por la similitud clínica con otras enfermedades. (8) por eso se debe sospechar esta entidad ante toda clínica de conjuntivitis crónica unilateral que no responde al tratamiento convencional. La canaliculotomía, con legrado de las concreciones, combinada con antibióticos tópicos, es el tratamiento estándar. ...
... La canaliculotomía, con legrado de las concreciones, combinada con antibióticos tópicos, es el tratamiento estándar. (8,9,10) A pesar del desarrollo tecnológico y de los medios diagnósticos, en la actualidad el método clínico es fundamental para el diagnóstico de estas afecciones. Una evaluación clínica minuciosa es esencial para el diagnóstico de la canaliculitis en la mayoría de los casos. ...
Canaliculitis is an uncommon infectious disease. It is often misdiagnosed due to its overlapping presentation to other common entities. A 56-year-old female patient is reported. She was referred to Ramón Pando Ferrer Cuban Ophthalmologic Institute, Ocular Plastic Surgery consultation, suffering from punctal swelling, discharge, and epiphora. At ocular examination was described conjunctival hyperemia, pouting punctum and mucopurulent discharge. Punctal regurgitation of concretions appears under syringing. It was confirmed acute canaliculitis with concretions in the left eye. A canaliculotomy was performed, and the concretions were removed. Routine clinical examinations helped to get a right diagnosis of canaliculitis and the surgical result was satisfactory.
In this article, we report a 10-year-old boy with acute bacteremia and left eye blindness. Culture from abscess drainage was positive for Streptococcus constellatus. Infection caused by S. constellatus is rare among children, and to our knowledge, this is the first report of this pathogen causing blindness. The rapidness of progression in this case is alarming. We also summarize other cases of S. constellatus infection.
Lacrimal canaliculitis (LC) is a rare infection of lacrimal passage, which is usually late diagnosed or misdiagnosed. Traditional lacrimal system tests barely provide a clear and definite understanding of the pathological changes in lacrimal passage. We presented three patients with asymptomatic and atypical symptoms who were misdiagnosed and were eventually diagnosed with chronic LC with assistance of 80‐MHz ultrasound biomicroscopy (80‐MHz UBM) and lacrimal endoscopy. To our knowledge, the mutual assistance of above two techniques diagnosing LC has never been reported, it can provide better images and observations of the canaliculus from the inside out and can guide the differential diagnosis.
