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Canaliculitis: causes, symptoms, diagnosis, treatment

Medical expert of the article

Ophthalmologist, oculoplastic surgeon
, medical expert
Last reviewed: 04.07.2025

Inflammation of the canaliculus (canaliculitis) often occurs secondarily against the background of inflammatory processes of the eyes and conjunctiva. The skin in the area of the canaliculus becomes inflamed. There is marked lacrimation, mucopurulent discharge from the lacrimal points.

Treatment of canaliculitis is conservative, depending on the underlying causes.

Inflammation of the lacrimal canaliculus (canaliculitis) is usually chronic, more often fungal. This is the most common ophthalmomycosis. Actinomycosis is most common, less often candidiasis and sporotrichosis. The lower lacrimal canaliculus is predominantly affected, less often both; usually the process is unilateral. At first, hyperemia of the lacrimal caruncle and transitional fold, lacrimation, crusts in the inner corner of the eye appear, then swelling along the lacrimal canaliculus occurs, resembling barley. The thickening along the canaliculus is painless, the lacrimal punctum is dilated and lags behind the eye, slight eversion of the eyelid is observed. When pressing on the lacrimal canaliculus, a cloudy pus-like liquid is released from the lacrimal punctum, sometimes with grains of stones.

Subsequently, the lacrimal punctum becomes blocked, the canaliculi stretch and perforate. Mycosis of the lacrimal canaliculi is accompanied by persistent conjunctivitis that is not amenable to treatment; occasionally, it becomes complicated: the cornea and lacrimal sac are involved in the process. Fungal canaliculitis is treated by widening the canaliculi and removing the stones, followed by lubricating the walls of the opened canaliculi with a 1% alcohol solution of brilliant green or a 5% iodine solution. The contents of the canaliculi must be examined for the presence of mycelium.

Damage to the lacrimal canals is possible with trauma to the inner part of the eyelids. Timely surgical treatment is necessary, otherwise not only a cosmetic defect but also lacrimation occurs. During the primary surgical treatment of the wound, the edges of the damaged lower lacrimal canal are aligned, for which Alekseev's probe is passed through the lower lacrimal point and canal, the mouth of the lacrimal canal, the upper lacrimal canal and its end is brought out of the upper lacrimal point.

After inserting the silicone capillary probe into the ear, the probe is removed with a reverse movement, and its place in the lacrimal ducts is taken by the capillary. The obliquely cut ends of the capillary are fixed with one suture, forming a ring ligature. Skin sutures are applied to the soft tissues at the site of their rupture. Skin sutures are removed after 10-15 days, the ring ligature is removed after several weeks.

Chronic canaliculitis is a relatively uncommon disorder caused by Actinomyces (anaerobic gram-positive bacteria). There are no specific predisposing factors for canaliculitis, while a diverticulum or obstruction of the canal due to congestion may contribute to the development of an anaerobic bacterial infection.

It manifests itself as unilateral lacrimation associated with chronic mucopurulent conjunctivitis, which is resistant to conventional treatment.

Pericanalicular inflammation characterized by swelling of the canaliculi and swelling of the punctum, clearly visible on slit lamp examination.

Curdy discharge consisting of lumps that can be caught by compressing the tubules with a glass rod

Unlike dacryocystitis, there is no obstruction of the nasolacrimal duct, stretching of the lacrimal sac or inflammation.

Treatment of chronic canaliculitis

  • local antibiotics such as ciprofloxacin 4 times a day for 10 days, but they are not always effective;
  • Canaliculotomy - a linear opening of the canal from the conjunctival side - is the most effective, although in some cases it can lead to scarring and dysfunction of the canal.

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