Dacryoendoscopy-guided re-canalization of canaliculops: Two case reports

Abstract

Rationale: Canaliculops is a rare condition, and only 11 cases have been reported previously. We report 2 cases of canaliculops, which were successfully treated using the new recanalization technique under dacryoendoscopy followed by bicanalicular lacrimal intubation.

Patient concerns: A 78-year-old man and a 76-year-old woman had 3- and 1-year histories of medial-upper eyelid swelling (left and right, respectively) without any inflammatory signs, history of periocular trauma, herpes infection, use of specific drugs, or ophthalmic diseases of note.

Diagnoses: The cystic lesions were evaluated using ultrasound biometry or computed tomography to find the lumen of the horizontal canaliculus was exceedingly expanded, and to confirm the clinical diagnosis of canaliculops.

Interventions: As the 2 cases of canaliculops were caused by upper puncta and common canaliculus obstructions, canaliculops of the upper eyelid were recanalized under dacryoendoscopic guidance, followed by bicanalicular intubation. The tubes were kept in situ involving bi-weekly irrigation and instillation of antibiotic and anti-inflammatory eye drops, and were removed after 2 to 3 months of follow-up.

Outcomes: Epiphora, and eyelid swelling were completely resolved immediately after the procedure, and the lesions did not recur on follow-up after more than 6 months.

Lessons: Eleven case series of canaliculops have been described previously, but this is the first report of this recanalization procedure offering a new, less invasive treatment option compared to complete or partial resection of the cystic lesion.

Figure 1

Serial images of the canaliculops in the left eye of a representative case. (A) Clinical photograph of the cystic mass at the medial upper eyelid (arrows) showing no evidence of inflammation. (B) Cross-sectional imaging using an ultrasound bio-microscope showing gourd-shaped ectasia of the canaliculus. (C) Horizontal section showing expansion of the entire canaliculus, about 9 mm in length, without any evidence of tumor, foreign body, or dacryolith.

Figure 2

Serial images of dacryoendoscopy showing the inner lumen of the canaliculops in the representative case. (A) The wall is smooth and clean without any evidence of inflammation. (B) Obstruction of the common canaliculus can be seen at the end of the cystic lesion (arrow).

Figure 3

Clinical photographs of the canaliculops in the representative case, immediately after lacrimal intubation. Note the cyst appeared deflated compared to that preoperatively shown in Figure 1A.