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Lacrimal Canaliculitis: A Major Review
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.
... Primary canaliculitis results from de novo dacryolith formation, while secondary canaliculitis is associated with infected lacrimal stents or punctal plugs. The most commonly implicated microbes include Actinomyces and Pseudomonas aeruginosa (6)(7)(8) . The management of punctal-canalicular stenosis focuses on creating an appropriate punctal opening, maintaining the anatomical patency of the canaliculi, and preserving the lacrimal pump function. ...
... Punctal atresia (absence of punctal opening), Grade 1: Punctum covered by a membrane or adhesion, Grade 2: Punctum smaller than normal but visible, Grade 3: Normal punctum, easily entered by a regular dilator, Grade 4: Small slit (<2 mm), Grade 5: Large slit (≥2 mm) (14) . • Clinical findings of lacrimal canaliculitis: include epiphora, pouting, mucopurulent discharge, concretions, redness, and medial canthal (6,7) . • Fluorescein dye disappearance test (FDDT) (2%): Used to evaluate tear clearance and symmetry after five minutes. ...
... Epiphora significantly impacts daily activities and has been shown to negatively affect vision-related quality of life (QOL) (1,19) . Epiphora can result from various etiologies, with punctal and canalicular stenosis being present in nearly 50% of affected individuals (5,7,20) . Accordingly, we think the application of the punctumcanaliculus continuum concept is crucial for the optimal management of epiphora, ensuring that both the punctal and canalicular components are addressed comprehensively. ...
... [3][4][5] However, there is a high risk of relapse, and patients often endure extended conservative therapy with limited success. 3,6,7 As a result, persistent epiphora and recurrent canaliculitis following canaliculotomy are frequently reported. 8 ...
... 2,10 Secondary canaliculitis, on the other hand, is intricately associated with punctal or intracanalicular plug placement (86.72%), as well as silicone intubation, radiotherapy, tumor in the lacrimal drainage system, and eyelash plug. 7 Despite its well-defined clinical manifestations, the rarity of canaliculitis and complicating factors make it challenging to diagnose. 10,11 In this patient, recurrent erythema of the left lower eyelid, a pouting punctum with purulent discharge, and the lack of prior ocular treatment suggested infectious primary canaliculitis. ...
This paper reports an unusual case of recurrent canaliculitis who had a long history of chronic rhinosinusitis with nasal polyps. A 74-year-old woman complained of recurrent redness, purulent discharge, and occasional tearing of the left eye for 1 year. She has a 40-year untreated sinusitis history, with recurrent mucopurulent rhinorrhea, nasal obstruction and hyposmia, and loss of smell for 2 years. The patient’s various symptoms, such as epiphora, purulent discharge, rhinorrhea, nasal obstruction, and anosmia, poorly responded to antibiotics and canaliculotomy. However, relief came from the unintentional usage of systemic corticosteroids. Canaliculitis is a rare form of inflammation involving the proximal lacrimal drainage system. Unfortunately, it is often misdiagnosed, has frequent recurrences, and fails to respond to therapy. This case highlights the importance of medical history, lacrimal examinations, and regular therapy in managing recurrent canaliculitis. For those canaliculitis patients with nasal symptoms, simultaneous treatment of nasal-related disorders should be considered.
... For complete removal of concretions, canalicular debridement in the form of canaliculotomy is the mainstay of treatment and is more effective than medical therapy. 15 In this case, bacterial concretion was about 10 mm, so extracting from the lacrimal puncta was difficult. We opted for DCR for the extracted bacterial concrete and treated the nasolacrimal obstruction. ...
... Another treatment option for bacterial removal is lacrimal endoscopy with curettage. 15,16 ...
Purpose
To report a case of lacrimal drainage pathway disease-associated keratopathy (LDAK) with endophthalmitis.
Observations
An 80-year-old man with diabetic retinopathy and nephropathy was referred to our hospital with endophthalmitis of the left eye. Slit-lamp examination revealed slight eye discharge, peripheral corneal ulcers, diffuse hyperemia of the conjunctiva, iris synechia, and a large amount of fibrin in the anterior chamber of the left eye. No puncta of the left eye were observed. The patient had undergone trabeculectomy for primary open-angle glaucoma 5 years previously. B-mode echo examination confirmed vitreous opacity in the left eye. We suspected endophthalmitis and performed a par-plana vitrectomy, bacterial culture, and polymerase chain reaction examination for eye discharge, aqueous humor, and vitreous humor. However, no bacteria or viruses were detected. The eye discharge and corneal peripheral ulcers did not improve following surgery. A lacrimal syringe test was performed two weeks after surgery, and bacterial concretion and discharge were observed. We detected Actinomyces in the bacterial concretions and performed dacryocystorhinostomy. After surgery, the corneal ulcer improved, and eye discharge disappeared.
Conclusions and importance
LDAK causes corneal perforation and endophthalmitis. In cases of intraocular inflammation with corneal ulcers, a lacrimal syringing test should be performed, even in the absence of lacrimal findings on slit-lamp examination.
AIM: To reveal the research hotspots, trends, and future prospects of lacrimal duct obstruction disease (LDOD) from 1900 to 2024 through the bibliometric and visualized analysis, providing a directional guidance for research in this field. METHODS: The Web of Science Core Collection database was used to retrieve relevant literature. Data analysis and visualization were conducted using VOSviewer 1.6.20 and CiteSpace 6.3.1, including annual publication volume, trends, research areas, country/region and institution distribution, journal and co-cited journal analysis, author and co-cited author analysis, keyword and burst keyword analysis, etc. RESULTS: The study included a total of 1481 articles, revealing an overall upward trend in research on LDOD, with ophthalmology being the predominant field. While the United States previously led research efforts, India and China have emerged as key contributors since 2015. Mohammad Javed Ali stands out as the most influential author in this research area. Ophthalmic Plastic and Reconstructive Surgery has published the highest number of related articles, whereas Ophthalmology has the highest co-citation. The current focal points of research include minimally invasive and precise modifications to dacryocystorhinostomy, along with intubation, new materials for stents, and disease pathogenesis. CONCLUSION: LDOD research has garnered widely attention and exhibits a steady upward trend. Since 1900, the United States, China, and India have been the leading contributors to this field. Ophthalmologists continue to be the primary driving force behind LDOD research. The findings of this study suggest that at the forefront of LDOD research, our focus has long been on refining and innovating surgical treatment. The minimally invasive and precise modification of lacrimal surgery, represented by dacryocystorhinostomy, is the ongoing developmental direction of this field. Rapid interdisciplinary integration and in-depth exploration of pathogenesis and allergic inflammation will lead to the emergence of new materials, innovative technologies, and safer clinical treatment protocols.
Objectives:
To evaluate the demographic characteristics, clinical presentation, microbiologic profile, and treatment results of patients with primary canaliculitis.
Materials and methods:
Patients diagnosed and treated for primary canaliculitis between May 2014 and May 2021 were analyzed retrospectively.
Results:
There were 26 patients with primary canaliculitis, including 17 females (65.4%) and 9 males (34.6%) with a mean age of 50.6±16.4 years (range: 9-80 years). Canaliculitis affected the right eye in 11 patients, the left eye in 13 patients, and bilateral involvement was seen in 2 patients. Inferior canaliculus involvement was more frequent (73%). The most common complaint was epiphora (46.1%). Five patients (19.2%) were wrongly diagnosed as chronic conjunctivitis. The time interval between the beginning of symptoms and canaliculitis diagnosis was 18.2±14.3 months (range: 1-60 months). Canaliculotomy and curettage of canalicular content with dacryolith removal were performed in 23 patients. After surgery, antibiotic irrigation of the canaliculus was added to the treatment regimen in 12 of these 23 patients. Intracanalicular antibiotic therapy was administered to the remaining 3 patients. The most cultured organism was Actinomyces (6 patients). Gemella (1 patient), Porphyromonas (1 patient), Candida parapsilosis (1 patient), Citrobacter koseri (1 patient) were also grown in culture. The follow-up time of patients was 26.2±23.7 months (range: 6-83 months). All symptoms and findings resolved in all patients in one month. In two patients, recurrence occurred at 4 and 16 months after surgical treatment. With appropriate treatment, no further recurrence was seen in either patient over 24-month follow-up. One patient presented with iatrogenic canaliculus blockage during follow-up.
Conclusion:
Primary canaliculitis is often overlooked and can be misdiagnosed. The most common symptom was epiphora. All patients with epiphora and chronic conjunctivitis should be examined carefully for canaliculitis.
Citrobacter koseri is a rarely reported ocular pathogen. It may induce severe peripheral corneal inflammation and subsequent perforation by canaliculitis. Timely detection of the reservoir of this pathogen would halt its progression. The purpose of this study was to report a rare presentation of C. koseri chronic canaliculitis complicated with perforating peripheral ulcerative keratitis (PUK). A 71-year-old female who had several episodes of C. koseri conjunctivitis in the past 6 months was admitted to our infection ward under the impression of fever that was suspected to be related to urinary tract infection. She had concurrent copious mucopurulent discharge and blurred vision. Ocular examination disclosed hyperemic conjunctiva and an oval-shaped corneal infiltrate at 5–6 o’c periphery, which later rapidly progressed to PUK and corneal perforation. Despite aggressive treatment, the cornea continued to thin, and a second perforation occurred. After meticulous examination of the ocular adnexa, irrigation of inferior canaliculi revealed pustular discharge with profuse concretions indicating chronic canaliculitis. A cutaneous-lacrimal fistula was also found. Frequent antibiotic irrigation of the canaliculus finally halted the corneal melting and the cornea healed. Although rare, C. koseri may not only cause chronic canaliculitis but also induce peripheral corneal inflammation mimicking autoimmune-related PUK. Identification of C. koseri from conjunctival swab cultures should prompt the physicians to check chronic persistent canaliculus infections, which may help prevent rapidly progressive corneal inflammation and thus perforation. Management of C. koseri canaliculitis-induced PUK must also include antibiotic irrigation to eradicate canaliculitis infection at the reservoir and not just topical antibiotics.
Objectives:
The aim of the study was to evaluate etiological and demographic characteristics of the adult patients referred to the oculoplastic surgery clinic of the tertiary care center with the complaint of epiphora.
Methods:
The medical records of the patients who applied to the oculoplastic surgery clinic with a complaint of epiphora between January 2014 and July 2021 were reviewed retrospectively. Etiology of epiphora, age, gender, duration of symptom, and follow-up period were evaluated. According to the etiological factors, nasolacrimal system disorders such as punctal stenosis, canalicular stenosis, canaliculitis, and acquired nasolacrimal system obstruction, respectively; the causes of epiphora were grouped as eyelid abnormalities such as entropion and ectropion, and hypersecretory tear secretion due to causes such as dry eye, allergy, and inflammation. The patients with epiphora over the age of 18 with at least 6 months of follow-up were included in the study. Patients with congenital or tumor-related nasolacrimal duct obstruction (NLDO) and epiphora due to trauma-related eyelid or canaliculi injury were not included.
Results:
A total of 595 medical fields were evaluated. Epiphora was present in 747 eyes of 595 patients. Of the patients, 221 (37%) were male and 376 (63%) were female. According to etiological evaluation of frequency, 372 (62.5%, 432 eyes) patients with NLDO, 63 (10.5%, 123 eyes) patients with punctal stenosis, 44 (7.3%) patients with ectropion, 38 (6.3%) patients with entropion, 37 (6.2%, 69 eyes) patients hypersecretory causes (dry eye, allergy, inflammation, etc.), 24 (4%) patients had primary canaliculitis, and 17 (2.8%) patients had epiphora due to canalicular occlusion.
Conclusion:
Epiphora is an important complaint that may occur due to different etiologies. A detailed examination of the anterior segment, lacrimal system and eyelids, and taking a history are the most important steps in the management of the patient.
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.
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.
As a rare and often misdiagnosed disease of the lacrimal apparatus, only limited data exist on long-term outcomes of surgical methods for the treatment of primary canaliculitis. The aim of this study was to evaluate canaliculotomy with silicone tube intubation (STI) as a surgical procedure for canaliculitis in a long-term follow-up setting. A total of 25 eyes of 25 patients with canaliculitis treated with canaliculotomy and STI at the University of Muenster Medical Center, Germany, from 2015 to 2021 were included in this study. Data analysis involved clinical symptoms, complications, duration of STI and rate of recurrence. Mean patient age was 63.7 ± 17.2 years. After a follow-up time of 3.7 ± 1.5 years, 88% of cases showed no recurrence of inflammation. The mean duration of STI was 5.8 ± 3.4 months. Complications such as post-operative hemorrhage, spread of infection, obstruction of the canaliculus or migration of the STI were not observed in any of the patients. However, tube dislocation occurred in four cases, a pyogenic granuloma in two cases and a fistula formation in one case. The management of canaliculitis by canaliculotomy with STI showed very good postoperative outcomes and low complication rates in the long-term and can therefore be considered a safe and successful surgical approach.
Purpose
To study the metagenomics of the microbes isolated from the canaliculus of patients with infective canaliculitis.
Methods
A prospective study was performed on five consecutive canalicular samples obtained for the metagenomic analysis from the patients with infective canaliculitis who underwent non-incisional canalicular curettage at a tertiary care Dacryology service. The canalicular concretions were collected intraoperatively soon after a canalicular curettage and immediately transported on ice to the laboratory. Following DNA extraction and library preparation, a whole shotgun metagenome sequencing was performed on the Illumina™ platform. The downstream processing and bioinformatics of the samples were performed using multiple software packaged in SqueezeMeta™ pipeline or MG-RAST™ pipeline.
Results
The taxonomic hit distribution across the samples showed that bacteria were the most common isolates (mean—80.5%), followed by viruses (mean—0.74%), and archaea (0.01%). The five major phyla identified across the samples of infective canaliculitis were, Fusobacteria, Bacteroidetes, Proteobacteria, Actinobacteria, and Firmicutes. The prevalent organisms include Fusobacterium nucelatum, Fusobacterium periodonticum, Parvimonas micra, Prevotella oris, Selonomonas noxia, Pseudopropionobacterium propoinicum, Campylobacter showae, and Streptococcus anginosus, amongst few others. Actinomycetes israelii was noted in all the samples, though it was not the most abundant. The microbial gene mapping and protein prediction demonstrated proteins with known functions to range from 69.91% to 87.09% across the samples. The functional subsystem profiling demonstrated genes associated with carbohydrate, amino acid, and co-enzyme transport and metabolism, cell wall or cell membrane biogenesis, energy production and conversion, transcription, translation, and cellular communications.
Conclusion
This is the first whole metagenome sequencing of infective canaliculitis. Infected canaliculi harbor diverse microbial communities, including bacteria, viruses, and archaea. Functional analysis has provided newer insights into the ecosystem dynamics and strategies of microbial communities.
Purpose:
Report the efficacy and safety of one-snip punctoplasty and 18-gauge irrigation technique in patients with primary canaliculitis.
Method:
All patients diagnosed with primary canaliculitis between January 2020 and August 2021 at Inje University of Busan Paik Hospital are included All patients underwent one-snip punctoplasty and 18-gauge irrigation technique. After the procedure, patients had topical antibiotics. The resolution of symptoms and inflammatory signs and complications were evaluated 3 weeks after the procedure.
Results:
11 patinets (8 women and 3 men, 14 canaliculi) aged 34 to 82 with a mean age of 63.8 ± 15.7 years were participated and common symptoms were epiphora, mucopurulent discharge, injection and common signs were discharge from punctum, pouting punctum, punctal erythema and swellling. Among 14 canaliculi, 12(85.7%) had complete resolution and 2 underwent second treatment which showed completed resolution after the treatment.
Conclusion:
One-snip punctoplasty and 18-gauge irrigation technique are minimally invasive to punctum and canaliculi and are a highly effective surgical procedure for patients with primary canaliculitis.
Chronic canaliculitis is an uncommon condition secondary to an infection of the lacrimal canaliculus, frequently caused by Actinomyces israelii. It is often misdiagnosed due to its symptoms mimicking more common pathologies and regularly fails to respond to antibiotics alone. Surgical intervention is the definitive treatment. We present a case of chronic canaliculitis with an unusual presentation.
With increased availability of sophisticated microbiological techniques for isolation, growth and identification of micro-organisms the spectrum of organisms is rapidly. Herein we report four cases of canaliculitis with unusual organisms and highlight their clinical significance. To the best of our knowledge, there are no reports of isolation of Brucella melitensis and Leuconostoc species reported in English literature; and only one report of isolation of Myroides species from canaliculitis exists. Sphingomonas paucimobilis, is an uncommon isolate in canaliculitis. Extremes of age and occupational exposure may be possible risk factors for infection with uncommon organisms. Clinical features at presentation do not vary greatly with uncommon or multi drug resistant organisms' hence sampling and microbiological assessment is warranted. The benefit of curettage in canaliculitis is manifold. Unusual organisms and opportunistic pathogens can be multi-drug resistant and determination of antibiotic susceptibility is important to initiate targeted therapy to ensure disease cure and prevent recurrences.
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.
Introduction: Canalicular curettage is a surgical procedure used to remove canalicular
contents and debris from canaliculi. It is usually indicated for chronic, persistent or
recalcitrant canalicular diseases with no resolution of symptoms after conservative
management. We describe 3 different cases of persistent canalicular diseases which
needed canalicular curettage to rescue from the conditions leading to successful
outcomes.
Cases and observations:
• Case 1: A 45/M presented with recurrent punctal granuloma 3 months after
DCR surgery. Canalicular exploration and curettage with one-snip punctoplasty
following excision of the mass revealed a segment of remnant silicone stent. There
was no recurrence of mass in subsequent follow up visits.
• Case 2: A 35/F presented with recurrent canaliculitis for last 6 months. Canalicular
curettage revealed multiple small calcified masses of varying size and shape. The
patient had good postoperative recovery and showed no recurrence of symptoms.
• Case 3: A 32/F presented with gradually increasing pedunculated mass arising out
of punctum for last one month. Excision of mass with canalicular curettage was
done. Biopsy proved it to be squamous papilloma of the canaliculi. There was no
recurrence of mass.
Conclusion: Canalicular curettage is a simple, safe and effective surgical intervention
to rescue from the recalcitrant canalicular conditions like canaliculitits, retained foreign
bodies, canalicular neoplasms leading to successful outcomes.
Key words: Canalicular curettage, Canalicular diseases, Canalicular neoplasm,
Canaliculitis.
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.
Rationale:
Canaliculitis is a frequently overlooked and misdiagnosed disease. Concurrent corneal ulceration with canaliculitis is uncommon. We report such a case.
Patient concerns:
An 87-year-old woman complained of swelling and pain of the right eye after acute angle closure glaucoma attack. Slit-lamp examination was compatible with the features of infectious keratitis, and the cultures from corneal scrapings grew Streptococcus anginosus later. Hourly topical vancomycin (25 mg/ml) was instilled, then the corneal ulceration improved initially but became stationary after 1-week treatment.
Diagnosis:
Discharge from the upper punctum was noted subsequently and canalicular concretions were found through curettage. The cultures from canalicular discharge and concretions also revealed the presence of S. anginosus. Thus, infectious keratitis secondary to canaliculitis was diagnosed.
Interventions:
Canaliculotomy was performed to remove the large concretion and vancomycin was injected locally.
Outcomes:
The corneal ulceration resolved after canaliculitis was appropriately treated.
Lessons:
Canaliculitis could be a reservoir for organisms that may make compromised corneas liable to infections. Only the appropriate diagnosis and aggressive treatment of canaliculitis leads to the eradication of associated corneal infections.
To investigate the efficacy of lacrimal endoscopy in the diagnosis and treatment of primary canaliculitis.
This is a retrospective, interventional study. Fifteen patients diagnosed as primary canaliculitis were investigated, who underwent surgery with lacrimal endoscopy from January 2015 to December 2017 at Zhejiang Provincial People's Hospital. Patients were subsequently followed post-operatively for at least 6 months. Pre- and post-operative main measurement included ocular surface symptoms, signs of canaliculitis, intraoperative images, treatment response and complications.
Twelve patients (12 eyes) were enrolled. Endoscopy was successful in revealing the residual concretion and pathological change of lacrimal duct. With its unique direct vision and micro drill, all concretions got removed and lacrimal ducts got patent. On postoperative month 6, all of the patients got cured with no signs of redness, swelling of the punctum and eyelid, epiphora with discharge and pain. None serious complications such as false canalicular passage were observed.
Lacrimal endoscopy is indispensable in diagnosis, treatment and follows up of primary canaliculitis. With less iatrogenic injury, higher resolution rate and direct observation of canalicular mucosa, lacrimal endoscopy should be widely applied in the management of lacrimal diseases.
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.
Rationale:
For the treatment of primary canaliculitis, 1,2,3-snip punctoplasty and canalicular curettage are commonly used; however, a recurrence rate of 6.6% to 22% has been reported. Herein, we describe a case of recurrent primary canaliculitis that was completely cured by 4-snip punctoplasty and canalicular curettage.
Patient concerns:
A 53-year-old woman was admitted to our hospital with chief complaints of epiphora, discharge, eyelid flare up, and swelling near the inferior lacrimal punctum in the left eye, which initially presented 6 months earlier.
Diagnosis:
Based on the aforementioned symptoms, the patient was initially diagnosed with bacterial conjunctivitis at a local ophthalmologic clinic and used antibiotic eye drops for 6 months. However, her symptoms did not improve and they worsened at 2 weeks prior to admission. She was subsequently diagnosed with chronic dacryocystitis and referred to our hospital for surgical treatment. Slit lamp examination results showed conjunctival congestion in the inner corner of the left eye, along with eyelid flare up, swelling near the inferior lacrimal punctum, and yellowish discharge and concretion from the lacrimal punctal orifice. Furthermore, punctal regurgitation was not observed in the lacrimal sac compression test. Thus, the patient was diagnosed with primary canaliculitis on the basis of her clinical symptoms and laboratory findings.
Interventions:
Based on the diagnosis of primary canaliculitis, 1-snip punctoplasty and canalicular curettage were performed, and the patient was prescribed oral antibiotics for 2 weeks together with topical antibiotics for 4 weeks. Overall, the patient's symptoms improved after surgery, but epiphora and yellowish discharge from the lacrimal punctal orifice developed again 2 months after surgery during outpatient follow-up. Based on the diagnosis of recurrent primary canaliculitis, 4-snip punctoplasty and canalicular curettage were performed, and the patient was prescribed oral antibiotics for 2 weeks together with topical antibiotics for 4 weeks.
Outcomes:
Over a 6-month follow-up period, the symptoms disappeared completely and no other findings were observed.
Lessons:
Four-snip punctoplasty and canalicular curettage are simple clinical procedures that can minimize the recurrence rate of primary canaliculitis. Hence, 4-snip punctoplasty and canalicular curettage should be considered as the 1st-line treatment for primary canaliculitis and recurrent cases.
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, surgical details, and microbial analysis of canaliculitis infection.
Purpose:
To evaluate the complications and the treatment results of SmartPlug-related complications.
Methods:
Retrospective review of all patients from a single medical hospital who received SmartPlug (Medennium, Inc., Irvine, CA) insertions from October 2007 to February 2014. All patients who developed SmartPlug-related canaliculitis and pyogenic granuloma were analyzed. Lacrimal irrigation with antibiotics was performed in most patients.
Results:
Six hundred thirty-one eyes received SmartPlug insertion and 18 eyes developed SmartPlug-related complications (14 canaliculitis and 4 pyogenic granuloma). The mean time interval from insertion to development of the complications is 3.0 (0.5-6.9) years. Sixteen eyes received lacrimal irrigation with antibiotics, and all the eyes showed improvement without recurrence. The other two eyes had recurrence of granuloma pyogenica only after surgical excision.
Conclusions:
SmartPlug-related complications, including canaliculitis and granuloma pyogenica, required long-term follow-up. Most of the complications can be cured by lacrimal irrigation of antibiotics.
Actinomyces israelii is a Gram-positive anaerobic organism commonly associated with canaliculitis in adults. Pediatric canaliculitis is relatively rare, especially in infancy. We report the case of an 11-month-old boy who presented with co-existing canaliculitis and congenital nasolacrimal obstruction. The presenting signs included epiphora, discharge, conjunctival congestion, and matting of lashes. On examination, punctual pouting, regurgitation, and yellow canaliculiths were noted. A punctoplasty and canalicular curettage were performed along with nasolacrimal probing. Microbiological tests confirmed the organisms to be A. israelii. We discuss the clinical features and management of Actinomyces-associated canaliculitis and review the available literature on pediatric canaliculitis.
Aim:
To report an atypical case of multiple viruses causing canaliculitis.
Methods:
Case report of a young female presenting with atypical course of refractory unilateral canaliculitis with complete mid-bicanalicular obstructions. Canalicular scrapings were subjected to immunofluorescence techniques and polymerase chain reactions to identify the viruses.
Results:
Investigations revealed a canaliculitis of multi-viral etiology; herpes simplex virus and varicella zoster virus. A canalicular curettage followed by topical acyclovir helped in the resolution of canaliculitis.
Conclusion:
An encounter with an atypical canaliculitis with negative bacteriology work up, suboptimal response to routine therapies, and mid-canalicular obstructions should alert the physician to investigate for viral etiology.
Purpose
To report a case with corneal perforation, presumably due to ocular cicatricial pemphigoid (OCP) and bacterial concretion derived from lacrimal canaliculitis.
Observations
A patient with OCP demonstrated adherence of concretion to the cornea of her right eye. She also demonstrated canaliculitis in this eye. We removed a whitish precipitate from the bottom of the corneal ulcer. When we flushed her lacrimal pathway, a marked amount of bacterial concretion and dense mucosa were refluxed from both puncta on the right side. On the next day, corneal perforation was visible from the area where concretion was removed. We performed punctoplasty and removed the bacterial concretion from the lacrimal canaliculus and sac. After the operation, her symptoms improved and corneal perforation recovered.
Conclusions and Importance
Both lacrimal canaliculitis and OCP can cause corneal perforation, and adherence of bacterial concretion onto the cornea is very rare. However, once it occurs, corneal perforation can rapidly follow. OCP sometimes causes corneal epithelial damage, which may influence adherence to concretion. Canaliculitis in patients with OCP should be managed carefully.
Case report:
An 84 year-old woman was referred for evaluation of a painless swelling with small purulent discharge in her left upper canaliculus, and an associated epiphora of one-month duration. The patient was diagnosed with acute primary canaliculitis. She was treated with topical and oral antibiotics, as well as topical corticoids for three months, with little response. Surgical treatment with left upper canaliculotomy and curettage was then performed, and Gemella haemolysans was identified from the curetted material. The patient had no recurrence of the disease two months after the surgery.
Discussion:
This is the first time that Gemella haemolysans is described as unique agent causing primary canaliculitis.
Purpose: Primary lacrimal canaliculitis (PLC) is a unique disorder which often gets misdiagnosed by the general as well as speciality-trained ophthalmologists. Elderly patients with history of chronic or recurrent epiphora with discharge, often get mislead towards chronic dacryocystitis. The aim of our report is to discuss the misleading diseases in our PLC patients and to revisit this hidden disease.
Methods: The patients of PLC who were previously misdiagnosed were studied. The clinical history, presenting clinical features, misdiagnosis, and final management of the patients is described.
Results: There were 5 misdiagnosed female patients. A history of chronic redness, watering, discharge, and medial canthal region edema lead to the misdiagnosis of chronic dacryocystitis in 3 (60%) and medial marginal chalazion in 2 (40%) cases. Slit-lamp examination revealed localized hyperemia (n = 5), classical pouting of lacrimal punctum (n = 3), and expressible purulent discharge (n = 3). Two patients without punctum pouting had an explicit yellowish hue/discoloration of the canalicular region. Our patients had a mean 4 visits before an accurate diagnosis. Three-snip punctoplasty with canalicular curettage was performed in three while two were managed conservatively. At last follow-up, all patients were symptom-free with punctum and canalicular scarring in three, who underwent surgery.
Conclusion: PLC is a frequently misdiagnosed clinical entity which delays the initiation of appropriate treatment. A succinct magnified examination of punctum and canalicular region can provide sufficient clues pivotal for accurate diagnosis.
Purpose
To report the clinical presentations, complications, and outcomes of Sphingomonas paucimobilis-specific lacrimal drainage infections.
Methods
A retrospective chart review of all patients diagnosed with Sphingomonas paucimobilis lacrimal infections and managed at a tertiary care Dacryology Service from November 2015 to May 2022 over a 6.5-year period were recruited and analyzed. Data collected include demographic details, clinical presentation, microbiological diagnosis, antibiotic susceptibility profiles, management, complications, and outcomes. The microbiological techniques employed were aerobic and anaerobic cultures, phenotypic identification with VITEK 2R system, polymerase chain reaction, antibiotic sensitivity profile and minimal inhibitory concentration.
Results
12 Sphingomonas-specific lacrimal drainage infections of 11 patients were identified. Of these five were canaliculitis and seven were acute dacryocystitis. All the seven acute dacryocystitis presented in an advanced stage; five were with lacrimal abscess and two with orbital cellulitis. The antibiotic susceptibility profile of canaliculitis and acute dacryocystitis were comparable and the organism was sensitive to several classes of antibiotics. The outcomes of punctal dilatation and non-incisional curettage were effective for canaliculitis. Patients with acute dacryocystitis had advanced clinical stage at presentation but responded well to intensive systemic management and had excellent anatomical and functional outcomes with dacryocystorhinostomy.
Conclusion
Sphingomonas-specific lacrimal sac infections can have aggressive clinical presentations and need early and intensive therapy. The outcomes are excellent with multimodal management.
Infective canaliculitis is a common canalicular disorder in
the developing world, and atypical presentations can easily
be misdiagnosed. A 38-year-old male presented with complaints
of pain and discharge from the right eye of thirteen
months duration. On examination, the right lower eyelid
showed a medial swelling associated with focal conjunctival
congestion (Figure 1A). On everting the lower eyelid,
pouting of the puncta with yellowish discharge along with
intense congestion of the inferior palpebral conjunctiva
and papillary hypertrophy were noticed (Figure 1B).
There was a granuloma arising in an area overlying the
distal lower canaliculus (black arrow, Figure 1B). Upon
efforts to express the contents, a canalicular fistula was
noted in the lower distal canaliculus, discharging yellowish
granular concretions (Figure 1C). It was these infective
concretions that were initially covered by the granulation
tissue. The granulation tissue was excised carefully. The
lower punctum was dilated and canalicular contents were
curetted, and expressed both from the punctal opening and
the canalicular fistula (Figure 1C). This was followed by
the 1% povidone-iodine irrigation of the canaliculi. The
curetted material (Figure 1D) was subjected to microbiological
analysis, which revealed Staphylococcus epidermidis
as the causative organism. Canalicular fistula associated
with chronic infective canaliculitis is a rare form of presentation.
It is important for the clinician to be aware of
this possibility when managing such chronic cases, and
suspect it in the presence of granulation tissue overlying
the canaliculus
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.
Introduction The LacriJet (FCI S. A. S. – France Chirurgie Instrumentation, Paris, France) represents a novel, simplified and preloaded system for monocanalicular or monocanaliculonasal nasolacrimal duct intubation. It is a further development of the Masterka and shall reduce the intubation time during the surgical procedure. The aim of the present study was to present first experiences with this system for different indications.
Material and Methods All patients who underwent nasolacrimal duct intubation with the LacriJet at the University of Muenster Medical Center in the period from March to November 2019 were included. The postoperative outcome was evaluated 3 to 6 months later.
Results In total, 12 nasolacrimal duct intubations with the LacriJet were performed at our center in the above-mentioned period. The main indication for intubation was congenital nasolacrimal duct obstruction (CNLDO). In addition, intubation was performed in cases with eye lid tumors involving the nasolacrimal duct, in a case of canalicular laceration and in a case of canaliculitis. In 3 cases, there was an early dislocation or a complete loss of intubation. Of these, 2 were cases with CNLDO and the third dislocation was due to manipulation by the patient. All in all, the functional results were satisfying.
Summary The use of the LacriJet is highly suitable for the treatment of CNLDO, stenting in canalicular laceration or lid tumours involving the lacrimal drainage system. However, the known disadvantages of monocanalicular intubation (dislocation, early loss of intubation) also occur with this type of system and a system briefing seems useful. The LacriJet therefore represents a modern and simple method for nasolacrimal duct intubation and can be used for various indications.
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.
Aim
The aim of the study is to describe intracanalicular antibiotic ointment loading as a treatment option for canaliculitis
Material and Methods
It was an interventional prospective study. The study was conducted over a 3 year period from June 2015 to June 2018. All patients of canaliculitis managed with intracanalicular antibiotic ointment loading and with a minimum follow up of 3 months were included in the study. The antibiotic ointment was loaded into the canaliculus based on the antibiotic sensitivity of the material expressed out from the canaliculus. Patients’ demographics, clinical details, microbiological profile and management outcomes were evaluated.
Results
A total of 24 patients were included in the study. Mean age at presentation was 58.41 ± 9.4 years. The right eye was involved in 15 (62.5%, p = .0424) cases. The incidence of lower canaliculus involvement (14, 58.33%, p = .022) was significantly higher as compared to the upper canaliculus (8, 33.33%). Staphylococcus epidermidis and Actinomyces israelii (6, 25%) were the most commonly isolated organisms. Mean number of intracanalicular antibiotic loading sessions required was 4.21 ± 1.69 (range 2–8). Complete resolution of canaliculitis was seen in all (100%) cases.
Conclusion
Canalicular antibiotic ointment loading is a minimally invasive, safe, and effective procedure. It preserves the anatomy and function of the punctum and canaliculus and can be considered as one of the management options for canaliculitis.
Purpose: To explore the performance of ultrasound biomicroscopy (UBM) and color Doppler flow imaging (CDFI) in the diagnosis of primary lacrimal canaliculitis.
Methods: Subjects with relevant symptoms of canaliculitis were prospectively recruited. UBM and CDFI were performed for presumptive diagnosis. Microbiology and histopathology were performed for definitive diagnosis.
Results: A total of 37 cases were recruited, including 25 cases of canaliculitis and 12 cases of non-canaliculitis. Pathogens were isolated in 13 canaliculitis cases, and the leading pathogens were Actinomyces (4 cases) and Streptococcus (4 cases). UBM and CDFI identified 24 canaliculitis cases (sensitivity = 96%) and 11 non-canaliculitis cases (specificity = 92%). The predictive factors for canaliculitis were lumen wall thickness >0.25 mm (P = .019) and intracanalicular concretions (P = .010). Other typical features were enlarged lumen (2.16 ± 0.25 mm) and hot-wheel sign-on CDFI (84%). These image findings were congruent with histopathologic changes.
Conclusion: Ultrasonography is a valuable tool to assist the diagnosis of canaliculitis.
(Clinical trial registration number: ChiCTR1900025411)
Retained intracanalicular foreign bodies are not
very common and can remain quiescent for long
periods. A male, aged 70 years, presented with
a right-sided epiphora with occasional discharge of
3-month duration. There was no history of any
associated swelling, redness, or pain. The patient
gave an unclear history of some surgical procedure
on eyelids for similar complaints 4 years ago, the
details of which were not available. Slit-lamp examination
revealed an effaced right upper punctum
with peri-punctal scarring. The right lower
punctum appeared normal but end-on evaluation
showed a yellowish-white opacity that could not
be accessed or expressed out in the clinic. The left
lacrimal drainage system was patent. Evaluation
with high magnification endoscope revealed the
right lower punctum to be dilated with an intracanalicular
well-defined, yellowish-white structure, in
close proximity with the medial wall of the
expanded vertical canaliculus (Figure 1, Panel A).
The lateral wall of the expanded canaliculus could
be discernible and showed edematous mucosal folds
(Panel B). Initial attempts to express it out using a small Meyerhof scoop and fine forceps were
unsuccessful. A single punctal snip was performed
and further endoscopic examination revealed the
yellowish-white lesion to be the partially missing
and deformed head of the mini-monoka stent
(Panel C). The retained stent was extubated (Panel
D) and this was followed by copious expression of
retained canalicular discharge (Panel E).
Post extubation, the external punctum appeared
dilated (Panel F) while the dacryoendoscopy examination
showed a patent canaliculus but with diffuse
edema and inflammation of the mucosa. The
patient was treated successfully with a combination
of topical antibiotics and steroids.
The current case demonstrates that prolonged
retention of intracanalicular monoka stent may
structurally mimic a large canalicular concretion
without much symptoms and signs. Any concretion-
like structure could well be an intracanalicular
foreign body. The presence of an intracanalicular
foreign body in the absence of typical clinical features
of canaliculitis with a quiet and expanded
punctum should arouse suspicion of a prolonged
retained mini-monoka stent.
Purpose:
The aim of this study was to examine electron microscopic features of canalicular concretions obtained from patients with canaliculiths.
Methods:
Canalicular concretions were obtained from 10 patients diagnosed as canaliculiths and were immediately fixed for ultrastructural analysis. Surface structure and transmission electron microscopical sections were studied. Multiple longitudinal and transverse ultrathin sections were obtained at different levels and all were studied using standard protocols of scanning electron microscopy and transmission electron microscopy.
Results:
Three different types of canalicular concretions were noted; predominantly coccoid and bacilloid, predominantly filamentous, and mixed varieties. The surfaces and the cut sections showed typical and distinctive features for each of the concretion types. The filamentous subtypes were common accounting for 50% (5/10) of all canalicular concretions. The surface of predominantly filamentous concretions revealed typical honeycomb patterns, the walls and base of which were formed by definitive and peculiar arrangement of Actinomyces. Transmission electron microscopy confirmed the findings of scanning electron microscopy and demonstrated typical structural features of Actinomyces and some other bacteria undergoing binary fission. The most interesting feature was the lack of immune cells and blood products within the substance of canalicular concretions as compared with the mucopeptide concretions.
Conclusions:
Ultrastructural features of canalicular concretions reveal 3 distinct microbial subtypes and opens up avenues toward better understanding of the etiopathogenesis of canaliculiths and possible structural resistance to host defenses or antibiotics.
Escherichia coli canaliculitis is an exceptionally rare organism to cause primary canaliculitis. The present case describes unilateral canaliculitis refractory to conventional therapy with a significant history of recurrent culture proven E. coli urinary tract infection. Microbiological analysis revealed E. coli bacilli and histological examination showed goblet cell metaplasia, subepithelial edema with acute and chronic inflammatory infiltrate. The possibility of an endogenous infection or autoinoculation secondary to urinary tract infection cannot be ruled out.
Objective: To describe the outcomes of punctal dilatation and non-incisional canalicular curettage in patients with infectious canaliculitis.
Methods: A retrospective analysis of 53 canaliculi of 47 eyes of 46 consecutive patients diagnosed with canaliculitis was performed from November 2015 to December 2018. All patients were treated with punctal dilatation and a non-incisional canalicular curettage. Parameters studied include demographics, clinical presentation, microbiological analysis, management and treatment outcomes. The outcome measures were clinical resolution of canaliculitis and resolution of epiphora.
Results: The mean age at presentation was 59.34 years with female preponderance (M:F = 19:28). Left eye was more affected (64%, n = 30) as compared to the right (36%, n = 17). Only one patient presented bilaterally. Lower canaliculus was most commonly involved (68%, n = 32). Six eyes showed involvement of both upper and lower canaliculus. Presenting symptoms include discharge (81%), swelling of the eyelids (64%), watering (55%), redness (51%) and pain (39%). Punctal dilatation and non-incisional canalicular curettage were performed using punctum dilator and a small chalazion scoop (1 mm Meyhoefer chalazion curette). Of the 53 involved canaliculi, 14 canaliculi of 14 eyes underwent a repeat curettage for complete resolution and 1 canaliculus underwent the same procedure thrice. The most common micro-organisms isolated were Streptococci species (28% cases). At a mean follow-up of 6.8 months, resolution of canaliculitis was achieved in all patients; however, epiphora persisted in two eyes (4%).
Conclusion: Non-incisional canalicular curettage is a minimally invasive technique with good preservation of the punctal and canalicular anatomy. It also facilitates good anatomical and functional outcomes in infectious canaliculitis.
Purpose:
To evaluate long-term outcomes of maintenance of lacrimal silicone stent for the management of functional epiphora after anatomically patent external dacryocystorhinostomy (DCR).
Methods:
We retrospectively reviewed the medical records of 101 eyes of 75 patients who were diagnosed to have functional epiphora after external DCR from 2005 to 2014. Functional epiphora was defined as epiphora that persisted or recurred even after patent DCR confirmed by a lacrimal irrigation test. Secondary silicone intubation was indicated when the patients wanted a further intervention. The stent was intended to be kept in situ unless there was a stent-related complication or the patient wanted removal.
Results:
In total, 34 of 75 patients (45.3%, 52 eyes) who agreed to the intervention underwent secondary silicone intubation. The success rates at 1, 3, and 5 years after surgery were 96.2%, 75.5%, and 70.2%, respectively. At the final follow-up (mean 72.7 ± 26.4 months), 32 (61.5%) eyes chose to retain the silicone tube: silicone stent was well maintained without epiphora and complications once inserted in 18 eyes (34.6%), whereas tube replacement was needed in 14 eyes (26.9%) because of nasal crust or whitish plaque formation on the tube surface. In 13 cases (25.0%), silicone stent was removed because of tube-related complications, and the most common complication was canaliculitis (n = 8, 15.4%).
Conclusions:
Secondary intubation and maintenance of the stent is an effective and simple procedure for functional epiphora. The main obstacle to long-term maintenance is tube-associated canaliculitis.
Purpose:
Tsukamurella is an important and emerging organism that causes opportunistic human infection. We present the largest case series of Tsukamurella species-associated ophthalmic infections, with an emphasis on clinical spectrum, risk factors, treatment, and outcome.
Methods:
A case series of culture-positive Tsukamurella species in ocular microbiological specimens was identified retrospectively from 2005 to 2018. Tsukamurella species were identified by phenotypic, molecular, and genotypic methods. Diagnoses were clinical and were supplemented by microbiological findings. Treatment including antibiotic type, number of antibiotics, treatment duration, and clinical outcome was documented.
Results:
Eleven cases of culture-positive Tsukamurella ocular infection were identified. Of these 54.5% (6/11) of cases resulted in conjunctivitis, 18% (2/11) of cases resulted in keratitis, and 9% (1/11) of cases resulted in blepharitis. One case of canaliculitis and 1 case of postenucleation ocular implant-related infection were reported, which were both novel findings. The presence of ocular implant and preexisting ocular surface diseases such as exposure keratopathy and ectropion were thought to be predisposing factors. We have demonstrated that treatment of Tsukamurella ocular conjunctivitis, keratitis, and blepharitis was effective using a combination therapy of 2 antibiotics (fluoroquinolone, fusidic acid, or chloramphenicol). Canaliculitis and ocular implant infection required further addition of oral antibiotics (macrolide or doxycycline), canaliculotomy, and removal of the infected implant for satisfactory management.
Conclusions:
Tsukamurella tyrosinosolvens and Tsukamurella pulmonis were found to be the predominant species that caused ocular infection. Ocular manifestation of Tsukamurella has a wider spectrum than that previously reported. A high-level of suspicion and a low threshold for microbiological sampling in cases with prolonged ocular surface infection are recommended to diagnose Tsukamurella infections.
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.
A 53-year-old male developed secondary canaliculitis after undergoing nasolacrimal intubation with a silicone stent. Negative cultures, symptoms refractory to antibiotics, and rapid resolution after stent removal suggest an immune reaction as the mechanism of canaliculitis. This case raises awareness of noninfectious hypersensitivity or hypersensitivity-like reactions as a potential acute or subacute complication of nasolacrimal stenting.
Purpose:
To assess the incidence of lacrimal drainage disorders across a tertiary eye care network in India.
Methods:
A 5-year retrospective review of all the patients who were diagnosed with lacrimal drainage disorders across the tertiary care network of L.V. Prasad Eye Institute was performed from January 2013 to December 2017. All the patient data were retrieved using all the diagnostic terms assigned to the lacrimal drainage disorders in the in-house electronic medical record system eyeSmart. The incidence of each disorder, demographic details, and clinical presentations were captured.
Results:
A total of 20,102 patients were diagnosed with lacrimal drainage disorders in the 5-year period. The 2 most prevalent disorders were primary acquired nasolacrimal duct obstruction (n = 10,364, 51.56%) followed by congenital nasolacrimal duct obstruction (CNLDO; n = 5394, 26.83%). The most frequently encountered proximal lacrimal disorder was punctal stenosis (n = 603, 3%). More than 2/3rd of the patients presented with epiphora as their presenting complaint (n = 13,907, 69.18%) followed by a discharge (n = 4023, 20.01%). Although two-thirds of the patient with primary acquired nasolacrimal duct obstruction were females (n = 7081, 68.32%), the same was not true for the CNLDO group, where there was a near equal gender distribution (M:F = 1.06:1). Predisposition to laterality was neither noted in primary acquired nasolacrimal duct obstruction nor in CNLDO. The prevalence of complex CNLDO was 16.80% (n = 907), the rest being simple CNLDO. It was easy to capture the incidence of lacrimal disorders with the electronic medical record system; however, the same was not true for the surgical details. The reasons for this were lack of clarity with surgical codes, no separate drop downs for success/failure or complications, and variations in the documentation.
Conclusions:
This study depicts the incidence of various lacrimal drainage disorders in a very large cohort of patients. There is a need to modify the International Classification of Diseases (ICD) classification to incorporate all the diagnostic terminologies commonly used so as to capture the real global scenario. The present study helped to further customize the electronic medical record system that caters to the intricacies of lacrimal disorders.
Background Canaliculitis is often misdiagnosed. There are several conservative and surgical treatment options.
Patients and Methods Retrospective analysis of 14 canaliculotomies in 10 patients with canaliculitis. The overall length of the surgically induced opening was measured and compared to the corresponding untreated lacrimal punctae. Lacrimal duct concrements were liberated and sent for microbiological and histological analysis. Patient satisfaction and relief of symptoms were documented as well as clinical findings.
Results Mean age was 59 ± 10 years (36 – 73 years) with balanced gender distribution. Mean follow-up time was 13 ± 8 months (4 – 27 months). Canaliculotomy was performed on 12 out of 14 inflamed canaliculi; in 2 cases, 3-snip punctoplasty was sufficient. The surgically induced length of the cuts was 1.7 ± 0.9 mm (0.4 – 3.7 mm). In 13 out of 14 cases, macroscopic concrements were found intraoperatively and actinomyces was verified histologically. Nine patients were free of symptoms postoperatively, and one patient manifested markedly less epiphora.
Conclusions The canaliculi remained open within the long-term follow-up period without any drawbacks to the lacrimal outflow. No recurrent infections were seen.
