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The condition may be misdiagnosed and treated as conjunctivitis, blepharitis, dacryocystitis, mucocele, and chalazion, thus leading to prolonged morbidity to the patient

About

• Inflammation of the lacrimal canaliculus
• It is part of the lacrimal drainage system
• It is usually due to infection

Aetiology

• The most common causative organism is actinomyces israelii
• Patient with poor nasolacrimal drainage, for example due to obstruction, are at higher risk of developing canaliculitis

Microbiology

• Actinomyces israelii is most common
• Staphylococcus and Streptococcus
• Others are Eikenella, Lactococcus, Nocardia, and fungi
• Pseudomonas aeruginosa is associated with Plug-associated canaliculitis

Clinical

• Commonly presents with pain and swelling at the corner of the eye
• Patient may experience excessive watering of the eye, particularly if the canaliculitis is associated with drainage obstruction
• Patient will often notice a purulent discharge from the medial canthus which can be expressed with pressure over the nasolacrimal sac
• Patients may notice that symptoms are worse in the morning, this is because of tear stasis during sleep
• Episodes are often chronic and recurrent, particularly if duct obstruction is not relieved

Investigations

• Canaliculitis is a clinical diagnosis and relies on history taking and examination
• Pressure over the nasolacrimal sac may express a purulent discharge, which is strongly suggestive of a diagnosis of canaliculitis
• Lacrimal syringing will help identify any obstruction

Management

• Warm massage and digital pressure over the nasolacrimal sac and syringing and irrigation along with Topical and sometimes systemic antibiotics
• Surgical drainage of the lacrimal system with relief of any obstruction. Various procedures available to improve drainage.
• Canaliculotomy is safe and effective and involves placing an incision on the posterior aspect of the canaliculus and removing the stones, concretions, necrotic epithelium and other debris, then irrigating with antibiotic solution. The incision may be left open or closed with or without a stent

References

• Canaliculitis
• Canaliculitis at Statpearls