Canaliculitis
โ ๏ธ Canaliculitis is often misdiagnosed as conjunctivitis, blepharitis, dacryocystitis, mucocele, or chalazion. This leads to delayed treatment and prolonged morbidity for the patient.
๐ About
- Inflammation of the lacrimal canaliculus, part of the tear drainage system.
- Usually due to infection.
- Tends to be chronic and recurrent if not properly treated.
๐งฌ Aetiology
- Most common causative organism: Actinomyces israelii.
- Patients with poor nasolacrimal drainage (e.g. obstruction) are at higher risk.
๐ฆ Microbiology
- Actinomyces israelii โ classically associated.
- Other bacteria: Staphylococcus, Streptococcus, Eikenella, Lactococcus, Nocardia.
- Fungal causes possible.
- Pseudomonas aeruginosa โ linked with plug-associated canaliculitis.
๐ฉบ Clinical Features
- Pain and swelling at the medial canthus (corner of the eye).
- Epiphora (watering of the eye), worse if associated with obstruction.
- Purulent discharge from medial canthus, expressed with pressure over the sac (โpouting punctumโ).
- Symptoms often worse in the morning due to overnight tear stasis.
- Recurrent, chronic course if obstruction persists.
๐ Investigations
- Primarily a clinical diagnosis (history and examination).
- Pressure over the sac โ expression of purulent material is strongly suggestive.
- Lacrimal syringing may demonstrate obstruction.
๐ Management
- Conservative: Warm massage, digital pressure, syringing/irrigation, topical ยฑ systemic antibiotics.
- Surgical: Relieve obstruction and clear concretions/debris.
- Canaliculotomy: Safe and effective โ incision on posterior canaliculus, removal of stones/concretions, irrigation with antibiotics. Incision may be left open or closed, with/without stent.
๐ References