Analysis of the diagnosis and treatment experience and etiological characteristics of 119 cases of primary canaliculitis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the clinical features, diagnosis and treatment experience and the distribution characteristics of pathogenic microorganisms of primary canaliculitis, and provide reference for its diagnosis and treatment. METHODS: Retrospective clinical study. A total of 119 cases(120 eyes)diagnosed as primary canaliculitis in the department of ophthalmology of Wuxi No.2 People's Hospital from June 2019 to February 2023 were included. The treatment methods were mainly divided into conservative treatment(removing canaliculus stones through lacrimal punctum combined with injecting antibiotic eye ointment into the tube)and surgical treatment. The inspection methods of pathogenic microorganisms included secretion smear microscopy and microbial culture.RESULTS: Primary canaliculitis was more common in middle-aged and older female, mainly manifested by long-term red eye and increased secretion; however, the majority was not accompanied by tearing. Totally, 118 cases(99.2%)had monocular disease, while 63 cases(63 eyes; 52.5%)had inferior lacrimal canaliculus disease. Laboratory examination: Among 119 cases(120 eyes), 4 cases(4 eyes)did not undergo laboratory examination, and the other 115 cases(116 eyes)were as follows: Gram staining microscopy of secretion smear showed that Actinomyces were detected in 102 cases(103 eyes; 88.8%), while no fungus was detected; Microbial culture: 85 cases(86 eyes; 74.1%)were positive for bacterial culture. A total of 111 bacterial strains were cultured, which contained 26 types of bacteria. Among them, 32 strains were aerobic(28.8%); 26 strains were anaerobic(23.4%); and 53 strains were facultative anaerobic(47.7%). The most common bacteria were streptococcus(20 strains), staphylococcus(13 strains), Propionibacterium(10 strains), and capnocytophaga(10 strains). Only 4 cases(4 eyes; 3.4%)of microbial cultures were positive for Actinomyces. Fungus was negative in all microbial cultures. Treatment: Of the 119 cases(120 eyes), 114 cases(115 eyes; 95.8%)were cured by conservative treatment of removing lacrimal canaliculus stones through lacrimal punctum and intracanalicular ointment infiltration(IOI), while 5 cases(5 eyes)were not effective in conservative treatment; however, all of them were cured after surgical treatment, and the cure rate for primary canaliculitis was 100.0%.CONCLUSION: The incidence of primary canaliculitis is low, and it is prevalent in middle-aged and older female. Single lacrimal canaliculus is more common, which could be missed and misdiagnosed in clinic. Actinomyces is the major pathogen observed mostly in mixed infections, with heterogeneous strains, mainly anaerobic or facultative anaerobic bacteria. Streptococcus and Staphylococcus are the most common whereas fungal canaliculitis is rare. The cure rate of primary canaliculitis is high after diagnosis, and IOI method is recommended as the initial treatment of canaliculitis.

Canaliculotomy with novel R-S lacrimal tube for canaliculitis under lacrimal endoscope / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical effect of canaliculotomy joint novel R-S lacrimal tube implantation under lacrimal endoscope for canaliculitis.<p>METHODS: Thirty-one patients(thirty-two eyes)diagnosed as canaliculitis were investigated from July 2016 to September 2019 in our department. All patients have treated with canaliculotomy joint lacrimal tube implantation under lacrimal endoscope. The patients were randomly divided into two groups. Group A was treated with novel R-S lacrimal tube for 15 cases 15 eyes, and group B was treated with annular silicone tube. They were removed the lacrimal tube after 2-3mo, and followed postoperatively for at least 1a. The treatment results were comparatively analyzed.<p>RESULTS: The effective rate was 93% in group A and 94% in group B(<i>P</i>>0.05). The mean time of lacrimal tube implantation of group A was 2.27±1.335min, and group B was 5.29±1.404min. The total rate of complications was 7% in group A and 47% in group B. The rate of foreign body sensation in nasal cavity was 7% in group A and 41% in group B. The rate of increased nasal secretions was 0 in group A and 29% in group B. The difference of the mean time of lacrimal tube implantation, the rate of complications, the rate of foreign body sensation in nasal cavity and the rate of increased nasal secretions between two groups was statistically significant(<i>P</i><0.05).<p>CONCLUSION: Canaliculotomy joint novel R-S lacrimal tube implantation under lacrimal endoscope is an effective way. The novel R-S lacrimal tube has the advantages of simple operation, less postoperative complications and high patient comfort.

Canaliculitis / Canaliculitis

RESUMEN La canaliculitis es una entidad rara, con frecuencia mal diagnosticada por su similitud con otras enfermedades. Se reporta una paciente femenina, de 56 años de edad, remitida a la Consulta de Oculoplastia del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", por secreciones purulentas y epífora del ojo izquierdo. Al examen se observó hiperemia conjuntival, secreción purulenta, punto lagrimal inferior hiperémico, dilatado, y se constató salida de concreciones por este al comprimir el canalículo. Se confirmó el diagnóstico de canaliculitis aguda supurada con concreciones. Se indicó tratamiento quirúrgico, que consistió en la canaliculotomía con remoción de las concreciones. Un examen clínico detallado, con adecuado conocimiento de la vía lagrimal excretora, permitió el diagnóstico certero, con un tratamiento quirúrgico eficaz y una evolución satisfactoria(AU)

ABSTRACT Canaliculitis is an uncommon infectious disease. It is often misdiagnosed due to its overlapping presentation to other common entities. A 56-year-old female patient is reported. She was referred to Ramón Pando Ferrer Cuban Ophthalmologic Institute, Ocular Plastic Surgery consultation, suffering from punctal swelling, discharge, and epiphora. At ocular examination was described conjunctival hyperemia, pouting punctum and mucopurulent discharge. Punctal regurgitation of concretions appears under syringing. It was confirmed acute canaliculitis with concretions in the left eye. A canaliculotomy was performed, and the concretions were removed. Routine clinical examinations helped to get a right diagnosis of canaliculitis and the surgical result was satisfactory(AU)

Actinomycotic lacrimal canaliculitis: a rare case report

Actinomyces israelii is a gram-positive anaerobic organism commonly associated with canaliculitis in adults. Actinomyces are normal commensal bacteria in humans and primarily cause opportunistic infections during immunosuppressive state or when loss of continuity of epithelial lining in mucosa occurs. Lacrimal canaliculitis is a relatively rare condition and is undiagnosed for long periods of time. Being a relatively rare condition, it is commonly overlooked and undiagnosed for long periods of time. Primary chronic canaliculitis is an uncommon problem and Actinomycosis may form in up to 2% of all lacrimal disease. Here present study reports a case of lacrimal canaliculitis caused by Actinomyces israelii.

Chronic lacrimal canaliculitis - the answer to a three-year history of red eye / Canaliculite lacrimal crônica - a resposta para uma história de olho vermelho com 3 anos de evolução

ABSTRACT 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.

RESUMO A canaliculite lacrimal crónica é uma infecção rara do sistema lacrimal e pode levar a erros de diagnóstico devido à sua apresentação sobreposta a outras entidades comuns. Os autores relatam um caso de canaliculite lacrimal com história de três anos de olho vermelho unilateral recorrente e secreção mucopurulenta. Aqui, descrevemos o curso clínico, os detalhes cirúrgicos e a análise microbiológica da infecção por canaliculite.

Comparison of the Efficacies of 0.94 mm and Double Silicone Tubes for Treatment of Canalicular Obstruction

PURPOSE: To compare the clinical effects of the single wide-diameter bicanalicular silicone tube and the double bicanalicular silicone tube in endonasal dacryocystorhinostomy (DCR) with canalicular trephinization for canalicular obstruction. METHODS: We retrospectively reviewed the records of 121 patients with monocanalicular or common canalicular obstruction who had undergone endonasal DCR with random bicanalicular insertion of either double silicone tubes (insertion of two tubes into each canaliculus) or a single wide-diameter (0.94 mm) silicone tube. The tubes were removed at around 3 months after surgery. RESULTS: This study included 79 eyes of 61 patients in the double-tube intubation group and 68 eyes of 60 patients in the single wide-diameter tube intubation group. Anatomical success, evaluated by syringing, was achieved in 72 of the 79 eyes (91.1%) in the double-tube intubation group and 60 of the 68 eyes (88.2%) in the single wide-diameter tube intubation group. Functional success was achieved in 65 of the 79 eyes (82.3%) in the double-tube intubation group and 61 of the 68 (89.7%) eyes in the single wide-diameter tube intubation group. There were no significant differences in the success rates of surgery between the two groups. One patient in the double-tube intubation group underwent conjunctivodacryocystorhinostomy (CDCR) and two in the wide-diameter tube intubation group underwent CDCR or reintubation to treat recurrence. CONCLUSIONS: Intubation using a single wide-diameter tube during endonasal DCR is as effective as double-tube intubation for the treatment of canalicular obstruction, with a lower rate of complications such as inflammation or patient discomfort.

A treatment method for chronic suppurative lacrimal canaliculitis using chalazion forceps.

Purpose: The purpose of this study is to evaluate the effectiveness of chronic suppurative lacrimal canaliculitis treatment using chalazion forceps. Patients and Methods: A prospective study was performed on consecutive patients who accepted the aid of chalazion forceps to treat chronic suppurative lacrimal canaliculitis. Two different treatment methods using chalazion forceps were performed according to the degree of lacrimal canaliculitis. Postoperatively, the patients received 0.5% levofloxacin eye drops four times per day and 0.5 g oral levofloxacin tablets once per day for 4 days. The follow‑up period was more than 3 months. Lacrimal irrigation, the condition of the lacrimal punctum, and patients’ symptoms were carefully evaluated. Results: In total, 32 patients met the criteria for chronic suppurative lacrimal canaliculitis. Included were 6 males and 26 females. Their average age was 51.7 ± 14.9 years (range; 19–80 years), and all had unilateral canaliculitis. The mean duration of the symptoms was 18.9 ± 9.8 months (range; 3–48 months). The mean follow‑up time was 14.7 ± 7.8 months. The signs and symptoms resolved completely in all patients within 15 days, and no recurrence was observed. No patients reported epiphora after the treatment. Conclusions: The use of chalazion forceps is effective in treating chronic suppurative lacrimal canaliculitis. The forceps may offer an alternative treatment technology in the management of suppurative lacrimal canaliculitis.

Therapeutic Effect of Squeezing the Punctum and Lacrimal Canaliculus in Canaliculitis Patients

PURPOSE: To report the therapeutic effect of squeezing the punctum and lacrimal canaliculus using Q-tips in canaliculitis patients. METHODS: From March 2004 to February 2014, 42 eyes of 42 patients diagnosed with canaliculitis at our clinic were retrospectively analyzed. To remove the discharge and concretions, the punctum and lacrimal canaliculus were squeezed using Q-tips without invasive procedures. RESULTS: The mean patient age was 56.39 years and mean follow-up period was 10.6 months. No statistical significance was observed in terms of rate of disease occurrence and mean age between males and females. Among the eyes analyzed, 30 (71.4%) were cured with only 1 squeezing procedure, 12 eyes (28.6%) required more than 2 procedures; 1 eye (2.3%) recurred and the period until recurrence was 3.8 months. CONCLUSIONS: Most studies support surgical management as the definitive therapy for canaliculitis to remove concretions that serve as a reservoir for bacteria. The gold standard treatments are curettage or canaliculotomy; however, these are not safe procedures and may result in epiphora in post-procedure patients due to the risk of lacrimal pump dysfunctioning or scarring of the canalicular system following invasive procedure. Squeezing punctum and lacrimal canaliculus only using Q-tips is effective in removing the canalicular concretions and without causing complications in the canalicular system.

A Case of Pseudomonas fluorescens Infection after Dacryocystorhinostomy and Silicone Tube Intubation

PURPOSE: To report a case of Pseudomonas fluorescens infection following endoscopic dacryocystorhinostomy and silicone tube intubation in a healthy patient who was using steroid nasal spray. In addition, a literature review is conducted. CASE SUMMARY: A 72-year-old female patient came to our clinic with tearing and hyperemia in the right eye. Ten months prior, she had undergone endoscopic dacryocystorhinostomy and silicone tube intubation due to nasolacrimal duct obstruction in the right eye. Six months after the first operation, dacryocystorhinostomy revision with silicone tube exchange was performed due to obstruction of the nasal bony orifice. In addition, the patient was using a steroid nasal spray. On slit lamp examination, conjunctival injection, marked inflammation and punctal edema around the tube were observed. The silicone tube was removed and the tube cultured. Pseudomonas fluorescens was isolated from the tube contents. The patients was treated with topical 0.3% gatifloxacin 4 times a day, methylol cephalexin lysinate 1000 mg 3 times a day and the nasal spray was discontinued. Two weeks later, all symptoms were resolved after treatment with antibiotic treatment. CONCLUSIONS: A case of Pseudomonas fluorescens canaliculitis which occurred in healthy patient who was using steroid nasal spray is presented with a literature review. Pseudomonas fluorescens canaliculitis can be treated by using proper antibiotics.

Diagnosis and Treatment of Chronic Canaliculitis

PURPOSE: To report on the clinical manifestations, species and treatments of patients with chronic canaliculitis. METHODS: From August 2003 to February 2012, 77 eyes of 77 patients who were diagnosed with chronic canaliculitis at our hospital were retrospectively analyzed. RESULTS: The mean period from the onset of symptoms to diagnosis was 4.7 months. The most common systemic disease associated with chronic canaliculitis was diabetes (18 eyes, 23%), and 13 eyes (17%) were related to punctual plug insertion. Main symptoms consisted of epiphora with discharge and pouting punctum. In the culture results of 55 eyes, streptococci, staphylococci, and actinomyces among other bacteria were identified. Seventy-two eyes (94%) were cured with one-snip punctoplasty with curettage. CONCLUSIONS: Chronic canaliculitis is rare, and the clinical aspect can be obscured by chronic conjunctivitis, thus the diagnosis is often delayed. In patients who have systemic diseases such as diabetes or past history of punctual plug insertion, chronic canaliculitis should be differentiated by observing the punctum more closely. If the diagnosis is accurate at the time, chronic canaliculitis could be easily cured by a relatively simple procedure such as one-snip punctoplasty with curettage.

Canaliculite: relato de caso e conduta / Canaliculitis: case report and conduct

A canaliculite é uma infecção rara e crônica do canalículo lacrimal, cuja etiologia mais comum é o Actinomyces israelli (bactéria gram positiva, anaeróbica). Esta afecção não apresenta cura espontânea. O diagnóstico diferencial se faz com: conjuntivite crônica recorrente, blefarite e hordéolo. O tratamento definitivo é o cirúrgico (canaliculotomia), sendo realizado sob anestesia local.

The canaliculitis is a rare infection and chronicle lachrymal pathology, whose commoner etiology is Actinomyces israelli ( bacteria anaeroby positive gram). This pathology does not present cure espontany The diagnosis differential with is done: Recurring chronic conjunctivitis, blefarity and hordeoly. The definitive treatment is the surgical (canaliculotomy)), being accomplished under location anesthetizes.

Treatment of the SmartPLUG-related Canaliculitis

PURPOSE: To report on the treatment approach of canaliculitis related to SmartPLUG use and its clinical manifestation. METHODS: A retrospective chart review of eight patients who had canaliculitis after the insertion of the SmartPLUG was conducted. RESULTS: Seven out of eight cases with canaliculitis related to the SmartPLUG required extraction of the SmartPLUG. While four cases were removed with only retrograde massage, two cases required surgical treatment. CONCLUSIONS: Canaliculitis related to SmartPLUG use is rarely reported. However, canaliculitis as a complication is difficult to treat and often leads to surgery. In canaliculitis related to SmartPLUG use, retrograde massage as a non-surgical method for the simple and effective removal of the SmartPLUG can be beneficial.

Canaliculitis Associated With SmartPlugtrade mark Punctal Plug Insertion: Clinical Features and Management

PURPOSE: To report the clinical features and treatment of canaliculitis associated with SmartPlug punctal plug insertion. METHODS: Case selection criteria included patients with canaliculitis, who were managed at Seoul National University Hospital from January 2006 to October 2008, presenting with a history of punctal plug insertion. The operation reports were reviewed to identify patients in whom SmartPlug was discovered during the operation. Six patients (8 eyes) were identified, and a retrospective chart review was performed for all the patients. RESULTS: The mean age of the patients was 34.3+/-8.6 years, and there were 1 men and 5 women. Common symptoms were mucous discharge (6 eyes) and conjunctival injection (2 eyes). The mean time from insertion of the plug to onset of symptoms was 27.0+/-27.0 months (range 4 to 77 months). All patients underwent surgical removal of the punctal plug by one-snip punctoplasty, canalicular retrograde compression using 2 cotton-tipped applications (2 eyes), or canalicular curettage (6 eyes). All patients had resolution of symptoms after the procedure. CONCLUSIONS: Canaliculitis should be considered when there is conjunctival discharge or injection in patients with SmartPlug. One-snip punctoplasty and retrograde compression of canaliculus can be attempted preferentially as a minimally-invasive treatment option.

A Case of Canaliculitis due to Actinomyces-Infected Nasolacrimal Stent in the Inferior Meatus / 대한이비인후과학회지

Actinomycosis of nasal cavity and paranasal sinuses is a rare chronic infectious disease. Canaliculitis is an uncommon condition which is developed from various causes. A case of canaliculitis due to actinomyces-infected nasolacrimal stent is reported.

Canaliculitis After Dacryocystorhinostomy with Silicone Tubes

PURPOSE: To investigate the incidence and clinical course of canaliculitis after dacryocystorhinostomy (DCR) with silicone tubes. METHODS: A retrospective analysis was performed on 521 eyes in 484 patients who had undergone DCR with silicone tubes between October 1994 and May 2006. RESULTS: Canaliculitis occurred in 11 eyes (2.1%). The mean age of the 10 patients involved in this study was 62.1 years (47~71 years) with a mean follow-up period of 11.1 months (6~36 months). The mean onset of canaliculitis was 3.2 months (1~5 months) after the surgery. All cases of canaliculitis were resolved with antibiotic treatment after silicone tube removal, and the surgical outcomes were successful in all patients. CONCLUSIONS: The incidence of canaliculitis after DCR with silicone tubes was rare. In such cases, the final surgical outcome was successful after appropriate treatment.

A Case of Chronic Granulomatous Canaliculitis Induced by Herrick Silicone Punctual Plug

PURPOSE: To report the experience of treating chronic granulomatous canaliculitis induced by permanent silicone punctal plugs used for dry eye syndrome treatment. METHODS: The transformation of puncta below both eyes and secretions in the lacrimal duct were observed for a 56-year-old female patient who had attended hospital for 4 months due to epiphora and secretions. Under the diagnosis of lacrimal duct inflammation for the lower lacrimal duct of both eyes, three-snip punctoplasty, curettage in the lacrimal duct, and pathological examination on the part of the lacrimal duct obtained from the three-snip punctoplasty were carried out. RESULTS: The lacrimal silicone plugs were removed from the lacrimal duct at the time of the lacrimal duct curettage, and a diagnosis was made based on tissue biopsy of chronic granulomatous canaliculitis induced by permanent silicone punctal plugs. After the above surgical operations, the epiphora and the anterior eye segment symptom both disappeared. CONCLUSIONS: The permanent silicone punctal plug used to permanently close the lacrimal punctum scarcely causes disorder in the lacrimal drainage system with epiphora and inflammation by acting as a foreign substance. It therefore should only be used when essential.

Diagnosis and Therapy of Canaliculitis

Canaliculitis is an uncommon condition. It is often difficult to diagnose because of its chronicity and its multitude of clinical presentations. We reviewed the nature, the diagnosis and therapy of six patients of chronic lacrimal canaliculitis. Bacteriologic investigation showed one case of E. coli, one case of alpha-hemolytic streptococcus, two of coagulase-negative staphylococcus and no growth to be seen in two cases. On dacryocystography, canalicular diverticulum were found in three cases. Five patients were treated with conservation therapy and one case improved with surgical treatment. Canaliculitis can be diagnosed by clinical features and dacryocystography. Conservative therapy should take priority to surgical treatment.