Microbiological isolates and associated complications of dacryocystitis and canaliculitis in a prominent tertiary ophthalmic teaching hospital in northern China.

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.

Efficacy and safety of super pulse CO2 laser-assisted punctoplasty with canalicular curettage in primary canaliculitis.

The objective of this study was to evaluate the efficacy and safety of super pulse CO2 laser-assisted punctoplasty with canalicular curettage in primary canaliculitis. In this retrospective serial case study, the clinical data of 26 patients who underwent super pulse CO2 laser-assisted punctoplasty for the treatment of canaliculitis were collected from January 2020 to May 2022. The clinical presentation, intraoperative and microbiologic findings, surgical pain severity, postoperative outcome, and complications were studied. Of the 26 patients, most were females (female:male 20:6), with a mean age of 60.1 ± 16.1 years (range, 19-93). Mucopurulent discharge (96.2%), eyelid redness and swelling (53.8%), and epiphora (38.5%) were the most common presentations. During the surgery, concretions were present in 73.1% (19/26) of the patients. The surgical pain severity scores ranged from 1 to 5, according to the visual analog scale, with a mean score of 3.2 ± 0.8. This procedure resulted in complete resolution in 22 (84.6%) patients and significant improvement in 2 (7.7%) patients, and 2 (7.7%) patients required additional lacrimal surgery with a mean follow-up time of 10.9 ± 3.7 months. The surgical procedure of super pulse CO2 laser-assisted punctoplasty followed by curettage appears to be a safe, effective, minimally invasive, and well-tolerated treatment for primary canaliculitis.

Chronic canaliculitis with canaliculoliths due to Providencia stuartii infection.

Canaliculitis, inflammation of the lacrimal canaliculi, can be caused by numerous pathogens, most commonly bacteria from the genera Actinomyces, Streptococcus, and Staphylococcus. Primary canaliculitis often requires surgical canaliculolith removal and appropriate antibiotic coverage. The authors report a case of a 77-year-old woman with a history of punctal plugs who presented with chronic canaliculitis with canaliculoliths that grew Providencia stuartii. P. stuartii has not previously been described as a cause of primary canaliculitis. This case highlights a new organism that causes canaliculitis with canaliculoliths and stresses the importance of speciation and antibiotic sensitivity testing following canaliculotomy and curettage. P. stuartii should be considered in the differential for bacterial canaliculitis with canaliculoliths, especially in patients with persistent symptoms on topical antibiotic therapy without canaliculotomy.

Clinical characteristics of lacrimal drainage pathway disease-associated keratopathy.

PURPOSE: To report the clinical characteristics of 13 cases of noninfectious corneal ulceration related to lacrimal drainage pathway disease. METHODS: Medical records of 13 patients with lacrimal drainage pathway disease-associated keratopathy who were examined at Ehime University Hospital between April 2007 and December 2021 were analyzed. RESULTS: The predisposing lacrimal drainage pathway diseases for corneal ulceration were chronic dacryocystitis in seven patients and lacrimal canaliculitis in six patients. The corneal ulcers were located at the peripheral cornea in 10 patients and the paracentral cornea in three patients. All patients indicated few cellular infiltrations of the ulcerated area at the slit-lamp examination. Corneal perforation was found in seven patients. The primary identified organisms were Streptococcus spp. in chronic dacryocystitis and Actinomycetes spp. in lacrimal canaliculitis. All patients showed rapid healing of the epithelial defects after treatment of the lacrimal drainage pathway disease. The mean time elapsed between treatment of the lacrimal drainage pathway disease and re-epithelialization of corneal ulcer was 14.5 ± 4.8 days. CONCLUSION: Lacrimal drainage pathway disease-associated keratopathy may be characterized by peripheral corneal ulcer with few cellular infiltrations, occasionally leading to corneal perforation. Treatment of the lacrimal drainage pathway disease could be the most effective treatment for lacrimal drainage pathway disease-associated keratopathy.

Campylobacter concisus as a pathogen of primary canaliculitis: a case report.

A 73-year-old woman presented to our hospital with a 1-year history of epiphora associated with discharge on the left eye. On the first examination, there was a swelling in the medial part of the left lower eyelid associated with a cystic change along the lacrimal canaliculus. On digital compression, there was an expression of a yellow mucopurulent discharge from the left-lower punctum. A culture test of the discharge showed Campylobacter concisus (1+), Gemella morbillorum (1+), Fusobacterium nucleatum (1+), and Porphyromonas gingivalis (2+). Complete removal of the canaliculoliths was done with a curette. Dacryoendoscopic examination showed a substantially dilated horizontal canaliculus accompanied with granulation and fibrous tissues on the left-lower side. An ofloxacin ointment-coated bicanalicular tube was inserted. Also, an oral antibiotic was administered for 14 days after surgery. At a 3-month follow-up, the patient did not have any symptoms associated with canaliculitis.

Metagenomic Shotgun Sequencing Analysis of Canalicular Concretions in Lacrimal Canaliculitis Cases.

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.

Utility of 80-MHz Ultrasound Biomicroscopy and Lacrimal Endoscopy in Chronic Lacrimal Canaliculitis.

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.

Intracanalicular antibiotic ointment loading as a management option for canaliculitis.

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.

Characteristics of lacrimal passage diseases by 80-MHz ultrasound biomicroscopy: an observational study.

PURPOSE: To investigate the microstructure of the lacrimal canaliculus and the characteristics of lacrimal canalicular diseases by 80-MHz ultrasound biomicroscopy (UBM). METHODS: This study included 33 participants: 20 normal subjects (40 eyes), 2 patients with chronic lacrimal canaliculitis (4 eyes), 10 patients with chronic dacryocystitis (16 eyes), and 1 patient with lacrimal punctum atresia (2 eyes). All participants underwent 80-MHz UBM; disease-specific features were noted. RESULTS: On 80-MHz UBM of the lacrimal canaliculi (vertical section) in normal subjects, low echo of the lacrimal canalicular lumen and high echo of the lacrimal canalicular wall were observed. The uniform low echo near the wall was the mucosal epithelium. The outermost layer of medium-to-high echo was the subepithelial elastic fibrous layer. In the horizontal section, the lumen was continuous. Two linear high echoes parallel to the canalicular wall could be observed at the center of the lacrimal canaliculus, which were sometimes attached and sometimes separated. When separated, the center of the lacrimal canaliculus was a low echo area (lumen). Lacrimal canaliculitis (vertical section) showed obvious ectasia of the lacrimal canalicular lumen, with a high echo mass shadow, which might have been calculi, and uneven thickness of the mucosal epithelium with a slightly high echo shadow. In the horizontal section, the lumen varied in size with clear boundaries of medium and high echoes. The central linear high echoes of the lumen were absent, and the echoes of the mucosal epithelium were discontinuous. In chronic dacryocystitis, the lacrimal canalicular lumen was extensively enlarged, with continuous echoes and uniform thickness of the mucosal epithelium and homogeneous patches of slightly higher echoes. Lacrimal punctum atresia indicated that the lacrimal canaliculus existed in both eyes and its structure was normal. CONCLUSIONS: The 80-MHz UBM is a new non-invasive technique that can be used for clear visualization of the fine structure of the lacrimal canaliculus, including the mucosal epithelium and subepithelial elastic fiber layer. The use of this approach will improve understanding of the hierarchical structure of the lacrimal canaliculi and provide a comprehensive basis for diagnosis, differential diagnosis, and treatment plan in patients with lacrimal passage diseases.

Surgical procedure of canaliculoplasty in the treatment of primary canaliculitis associated with canalicular dilatation.

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.

Punctal dilatation and non-incisional canalicular curettage in the management of infectious canaliculitis.

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.

[Formation of concrements in the lacrimal excretory system]. / Konkrementoobrazovanie v slezootvodyashchikh putyakh.

Studying the pathogenesis of concrements formation in lacrimal ducts is of fundamental and practical importance. This article attempts to analyze available information related to the pathogenesis of this phenomenon, provides information on the etiopathogenesis, physical and chemical properties of concrements obtained from horizontal and vertical parts of the lacrimal duct, and considers in detail bacteriological and mycotic composition of concrements, as well as various theories of their formation. The analysis helped justify the need to separate the concrements formed in the horizontal and vertical parts of the lacrimal ducts on the basis of differences in their pathogenesis. Actinomycotic infection is the cause of concrements formation in the horizontal part of the lacrimal duct in the overwhelming majority of cases. The process of concrements formation in the vertical part of the lacrimal duct in some cases occurs as a result of previous clinical events, but in many other cases the trigger mechanisms remain unknown. To date, the role of the initial narrowing of the lacrimal ducts in the pathogenesis of concrements is not clearly defined. The accumulated knowledge regarding the pathogenesis of concrements is currently not enough to formulate a complete theory of the development of this phenomenon. Further studies of the pathogenesis of concrements will help develop new diagnostic and therapeutic measures aimed at restoring the patency of the lacrimal ducts.

Multi-viral canaliculitis: case report and review of literature.

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.

[Etiological and drug sensitivity analysis of lacrimal canaliculitis].

Objective: To analyze the etiology and drug sensitivity of lacrimal canaliculitis. Methods: Retrospective study of case series. The general information, culture results and drug sensitivity results of 52 patients (including 10 males and 42 females with an average age of 60.3 years) clinically diagnosed with lacrimal canaliculitis during 2011 and 2016 at Beijing Tongren Hospital of Capital Medical University have been analyzed. The enumeration data have been tested with Chi-square method. Results: The positive rate of bacterial culture was 78.8%, and the fungal culture tests of all cases showed negative results. Sixty strains of bacteria were isolated from 41 patients whose bacterial culture tests showed positive results, Gram-positive bacteria have been confirmed as the main among the isolated bacteria with Streptococcus (18.3%), Propionibacterium (18.3%), and Streptococcus (15.0%) identified as the three common genera. Thirteen cases (25.0%, all the 13 patients were female) involved with mixed infection, 13.3% (8/60) of the isolated strains were multi-drug resistant bacteria. The drug sensitive rate of the bacteria to fluoroquinolones antibiotics(79.3%, 230/290) was higher than that to cephalosporins(62.1%, 36/58) and aminoglycoside antibiotics(56.3%, 98/174), and such differences are of statistical significance (χ(2)=7.977, 27.738, P<0.05). Except for the fact that gram-positive bacteria are mostly sensitive to vancomycin, the sensitive rate of the bacteria to gatifloxacin was the highest and that to tobramycin was the lowest. Conclusion: Lacrimal canaliculitis tend to affect women and elderly patients. Staphylococcus, Propionibacterium, and Streptococcus are the three most common genera. Gatifloxacin may be the preferred antibiotic. Antibiotics combination therapy should be applied for multi-drug resistant bacteria. (Chin J Ophthalmol, 2018, 54: 111-114).

Aggregatibacter aphrophilus chronic lacrimal canaliculitis: a case report.

BACKGROUND: Chronic canaliculitis is often misdiagnosed as conjunctivitis, delaying proper documentation and management. Aggregatibacter aphrophillus has not been implicated in chronic canaliculitis. CASE PRESENTATION: We report a case of unilateral chronic epiphora associated with chronic lacrimal canaliculitis resistant to prolonged topical antibiotic treatment in a 65-year-old woman without notable medical history. Canaculotomy, curettage with removal of concretions and tubing with silicone stent for six weeks resolved this chronic infection. Culturing lacrimal secretions and concretions yielded Aggregatibacter aphrophilus in pure culture. Histological analyses showed elongated seed clusters surrounded by neutrophils. Fluorescence in Situ Hybridization confirmed the presence of bacteria in two distinctive concretions. CONCLUSION: This first documented case of A. aphrophilus chronic lacrimal canaliculitis illustrates that optimal surgical management of chronic lacrimal canaliculitis allows for both accurate microbiological diagnosis and treatment.

[Concretions and iatrogenic foreign bodies in the lacrimal system : Treatment recommendations]. / Konkremente und iatrogene Fremdkörper der ableitenden Tränenwege : Therapeutische Empfehlungen.

BACKGROUND: Deposits (dacryoliths or foreign bodies) inside the lacrimal system can cause chronic inflammation and recurrent lacrimal stenosis. Furthermore, dacryoliths can occur due to chronic inflammation. OBJECTIVE: Considering typical clinical courses, the different localizations and surgical options for removing deposits from the lacrimal system are demonstrated. MATERIALS AND METHODS: A retrospective analysis of 1451 lacrimal surgeries in 1131 patients was performed. Fourteen representative lacrimal surgeries of 11 patients were retrospectively analyzed in terms of current complaints, prior surgery, and the performed surgical intervention. In three cases, histologic findings of removed dacryoliths were assessed. The surgical approaches are described using precise photodocumentation. RESULTS: In 220 lacrimal surgeries (15.2 %), dacryoliths were detected. Iatrogenic foreign bodies were found in 0.8 % (n = 12). All chosen patients suffered painful chronic inflammation of the lacrimal system. Localization was either intrasaccular or intracanalicular. In 10 eyes, surgery was performed using a transcanalicular dacryoendoscope, either alone or in combination with another method. An external approach (transcutaneous/transconjunctival) was performed in 4 patients. Regarding the whole study population, dacryoliths were found in 16.9 % (n = 91) of dacryocystorhinostomies, in 14.6 % (n = 77) of dacryoendoscopies, and in 35.6 % (n = 52) of canaliculotomies. CONCLUSION: Foreign bodies and dacryoliths are important differential diagnoses in the treatment of chronic dacryocystitis. Different surgical approaches are possible and should be available for treatment. Patients' history often reports prior lacrimal surgery.

Actinomycosis of eye: Forgotten but not uncommon.

Actinomyces species are known to cause a variety of human infections. Ocular actinomycosis is a rare disease. We report an unusual case of bilateral actinomycotic blepharoconjunctivitis in the absence of canaliculitis that presented with forniceal masses in eye. The case report is discussed here along with Indian literature.

Incision-sparing management of canaliculitis.

PURPOSE: To report our results of canaliculitis treatment with our incision-sparing technique which includes dilation of the punctum and compression of the canaliculus to express the sulphur granules, curettage and irrigation of the canaliculus with antibiotic solutions, and topical antibiotic use. METHODS: The medical records of all patients treated for canaliculitis between October 2009 and March 2013 were rewiewed. The punctum of affected canaliculus was dilated under local anesthesia. Then, starting just distal to common canaliculus, the horizontal canaliculus was compressed along its entire length using either a forceps or a cotton tip applicator on the conjunctival surface and a curette on the skin. Compression was repeated until no more sulphur granules appeared and the swelling of the canaliculus disappeared. A chalazion curette was inserted into canaliculus to evacuate any residual concretions. The canaliculus were irrigated with antibiotic solutions and the patients were prescribed topical antibiotic solutions for one month Patients with follow-up less than 3 months after the intervention were excluded from the study. RESULTS: Nine patients met criteria for canaliculitis. There were 1 male and 8 female patients. Median age of the patients was 53 years (range 36-72 years). All patients had unilateral lower canaliculitis. Mean duration of the symptoms was 13.4 months (range 4-36 months). We followed up all patients for at least 3 months after the intervention. The signs and symptoms resolved completely in all patients within 1 month and recurrence was not observed in any patient. No patients reported epiphora after the procedure. CONCLUSION: Our incision-sparing technique is effective in the treatment of canaliculitis. We suggest that minimally invasive or incision-sparing techniques be attempted before canaliculotomy to decrease postoperative complications rates.

Lacrimal Canaliculitis: A Major Review.

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.