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Canaliculitis

by James Garrity, MD

Canaliculitis is inflammation of the canaliculus (see Figure: Anatomy of the lacrimal system.).

The most common cause is infection with Actinomyces israelii , a gram-positive bacillus with fine branching filaments, but other bacteria, fungi (eg, Candida albicans), and viruses (eg, herpes simplex) may be causative. Symptoms and signs are tearing, discharge, red eye (especially nasally), and mild tenderness over the involved side. An increasingly common cause of canaliculitis is a retained punctal plug (inserted as treatment for dry eyes) that has migrated into the canaliculus from the punctum.

Diagnosis is suspected based on symptoms and signs, expression of turbid secretions with pressure over the lacrimal sac and canaliculus, and a gritty sensation caused by necrotic material that can be felt during probing of the lacrimal system. Canaliculitis can be differentiated from dacryocystitis (see Dacryocystitis). In canaliculitis, the punctum and canaliculus are red and swollen; in dacryocystitis, the punctum and canaliculus are normal, but a red, swollen, tender mass is located in or near the lacrimal sac.

Treatment is warm compresses, irrigation of the canaliculus with antibiotic solution (by an ophthalmologist), and removal of any concretions or foreign bodies, which usually requires surgery. Antibiotic selection is usually empiric with a 1st-generation cephalosporin or penicillinase-resistant synthetic penicillin but may be guided by irrigation samples.

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