Corneal ulcers with non-infectious appearance caused by nasolacrimal duct obstruction or canaliculitis

Abstract

Purpose: To describe the clinical features of corneal ulcers with non-infectious appearance due to nasolacrimal disease in a retrospective case series.

Observations: Eight eyes of 8 patients (aged 74.4 ± 11.1 years) with corneal disease due to nasolacrimal duct obstruction or canaliculitis, who were treated between October 2013 and December 2020 at 3 hospitals were included. Patient background, anterior ocular findings, organisms in secretion, and time course during treatment were retrospectively analyzed. The corneal findings were peripheral ulcers (5 cases), phlyctenular keratitis (1 case), and paracentral perforation with slight cellular infiltration (2 cases). All cases were suspected as autoimmune disease-related-corneal ulcers because of the pathogenic region and clinical appearance and later diagnosed as corneal disorders derived from nasolacrimal duct obstruction or canaliculitis. The autoimmune disease-like appearance and purulent secretion connecting the punctum with/without swelling were characteristic. The most common microorganism detected in the purulent secretions was Streptococcus spp.. The resolution of corneal lesions needed steroid eye drops with antibiotic eye drops. Two patients required a superficial corneal transplantation. The extraction of nasolacrimal calculus, punctal tube insertion, or dacryocystorhinostomy was necessary for complete healing of ocular surface disease.

Conclusions and importance: Nasolacrimal duct diseases cause corneal disorders without bacterial colonization and growth. When corneal ulcers resemble autoimmune disease in shape and are not accompanied by systemic disease, attention should be paid to nasolacrimal duct obstruction or canaliculitis.

Keywords: Canaliculitis; Corneal perforation; Corneal ulcer; Nasolacrimal duct obstruction.

Fig. 1

Representative slit-lamp biomicroscopic photograph of cornea in cases 1 and 2 Case 1: (a) Paracentral corneal perforation with slight cellular infiltration is found on the nasal side. (b) String-like mass of white purulent discharge is seen accumulated in the inner canthus. Case 2: (c) Corneal peripheral ulcer extending from 1 to 6 o'clock position is similar to an ulcer due to autoimmune disease. (d) White purulent discharge is noted emerging from the punctum and accumulating in the inner canthus.