Incision-sparing management of canaliculitis: an efficacious alternative to surgical management

Abstract

Objective: The aim of this study was to describe the outcomes of conservative (punctal dilation, manual expression, microcurettage, and canalicular irrigation with antibiotics) and surgical (punctoplasty) modalities for the management of canaliculitis in an Asian population.

Methods: The medical records of 11 consecutive patients (12 eyes) presenting with canaliculitis to one surgeon from August 2010 to January 2014 were reviewed. The clinical presentation, findings, management, microbiology, and treatment outcomes were studied.

Results: The mean age was 70.6 years (57-91 years), 8 (72.7%) patients were females, and all 11(100%) were Chinese. The majority had unilateral canaliculitis-8 (66.7%) right eye only and 4 (33.3%) left eye only (1 patient had consecutive right canaliculitis followed by left canaliculitis)-involving the lower canaliculi (75%). Ten (83.3%) eyes had primary canaliculitis, and 2 (16.7%) eyes had secondary canaliculitis from punctal plug insertion. Common presenting symptoms included eye discharge (75%) and eyelid swelling/redness (50%). Common clinical signs included mucopurulent punctal regurgitation (75%) and pouting punctum (58.3%). Facultative anaerobes (56.3%) formed the majority of organisms, and the most common bacteria isolated were Streptococcus spp. (18.8%). Mean duration to definitive treatment was 35 days (0-126 days). Ten (83.3%) eyes were successfully treated with incision-sparing modalities, and 2 (16.7%) eyes were treated surgically. No recurrences were observed at 3, 6, and 12 months, and only 1 (10.0%) of the 10 conservatively managed eyes had a recurrence of canaliculitis after 3.8 years.

Conclusions: Surgical modalities remain effective for the treatment of canaliculitis. However, they are not without disadvantages, such as scarring, discomfort, infection, and recurrence of punctal stenosis. In our experience, incision-sparing modalities are effective in the treatment of canaliculitis and have low recurrence rates.