Canaliculitis presents with persistent weeping and discharge, sometimes accompanied by a follicular conjunctivitis centered in the medial canthus. The punctum is often erythematous and dilated, or “pouting.” A cotton-tipped applicator can be used to apply pressure to the canaliculus (“milking”). The expression of purulent discharge confirms the diagnosis (Fig 15-24). A variety of bacteria, viruses, and mycotic organisms can cause infection within the canaliculus, most commonly A israelii.
Canaliculitis can be difficult to eradicate. Conservative management consists of warm compresses, digital compression, and topical and sometimes oral antibiotic therapy. Culture of the discharge may be useful in identifying the cause of the infection. Many patients require more aggressive treatment, particularly those with the formation of concretions (dacryoliths) or a retained intracanalicular plug, which protects the organisms from lethal antibiotic concentrations. Curettage through the punctum is sometimes successful at removing multiple stones, but often a canaliculotomy is required to completely remove all particulate matter. Drainage can be facilitated by an incision through the puncta or through the canaliculus (Video 15-4). The incision is left open to heal by second intention and does not usually require stenting. Some surgeons irrigate or paint the canaliculus with povidone-iodine or irrigate with specially formulated penicillin-fortified drops perioperatively.
Treatment of canaliculitis. Courtesy of Bobby S. Korn, MD, PhD.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.