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Ophthalmology – Canaliculitis
Canaliculitis is an acute or chronic inflammation of the lacrimal canalicular system, most often affecting the lower canaliculus. It is a relatively rare condition but occurs more frequently in adults and shows a strong female predominance (approximately 6:1). The condition is often underdiagnosed because it can mimic other causes of chronic red eye or discharge.
The underlying pathophysiology involves obstruction of the canaliculus, which leads to stagnation of tears and subsequent infection. Over time, this results in inflammation and the formation of concretions (dacryoliths) within the canaliculus. These concretions can harbor bacteria and make the infection persistent or recurrent.
The most common causative organisms include Streptococcus and Staphylococcus species, as well as Actinomyces and Propionibacterium. In many cases, infections are polymicrobial. Risk factors include prior placement of intracanalicular plugs, recurrent conjunctivitis, dacryocystitis, and chronic dry eye conditions.
Patients typically present with epiphora (excessive tearing), localized pain, and swelling near the punctum. A key feature is mucopurulent discharge, often expressed when pressure is applied over the canaliculus. On examination, the punctum may appear dilated and edematous, and the canaliculus is usually tender and erythematous. Slit-lamp examination often reveals discharge from the punctum and localized inflammation.
Diagnosis is largely clinical but can be supported by additional findings. Expression or probing of the canaliculus may yield concretions, which is highly diagnostic. Cultures and sensitivity testing can help guide antibiotic therapy, and fungal cultures may be considered in atypical cases. If the condition appears to extend beyond the canaliculus, imaging such as dacryocystography may be used to evaluate for deeper involvement or foreign bodies.
The differential diagnosis includes conditions such as dacryocystitis, chalazion, and mucopurulent conjunctivitis. Differentiation is important because treatment strategies differ significantly.
Initial treatment includes topical antibiotics, such as penicillin eye drops (100,000 units/mL) four times daily for two weeks, or sodium sulfacetamide if penicillin is unavailable. Warm compresses are also recommended to help reduce inflammation and promote drainage. However, medical therapy alone is often insufficient.
Definitive treatment typically requires a minor surgical procedure. Canaliculotomy, which involves making an incision into the canaliculus, allows for removal of all concretions. Complete removal is essential for cure, as retained material can lead to recurrence. Postoperatively, patients are usually treated with broad-spectrum antibiotic drops.
Prognosis is excellent, with nearly 100% cure rates when all concretions are removed. Complications are uncommon but may include recurrence if debris is not completely cleared, or, rarely, canalicular scarring leading to persistent tearing. Early recognition and appropriate management are key to preventing chronic symptoms and recurrence.
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