A case report on complete cure of recurrent primary canaliculitis by 4-snip punctoplasty and canalicular curettage

Abstract

Rationale:For the treatment of primary canaliculitis, 1,2,3-snip punctoplasty and canalicular curettage are commonly used; however, a recurrence rate of 6.6% to 22% has been reported. Herein, we describe a case of recurrent primary canaliculitis that was completely cured by 4-snip punctoplasty and canalicular curettage.Patient concerns:A 53-year-old woman was admitted to our hospital with chief complaints of epiphora, discharge, eyelid flare up, and swelling near the inferior lacrimal punctum in the left eye, which initially presented 6 months earlier.Diagnosis:Based on the aforementioned symptoms, the patient was initially diagnosed with bacterial conjunctivitis at a local ophthalmologic clinic and used antibiotic eye drops for 6 months. However, her symptoms did not improve and they worsened at 2 weeks prior to admission. She was subsequently diagnosed with chronic dacryocystitis and referred to our hospital for surgical treatment. Slit lamp examination results showed conjunctival congestion in the inner corner of the left eye, along with eyelid flare up, swelling near the inferior lacrimal punctum, and yellowish discharge and concretion from the lacrimal punctal orifice. Furthermore, punctal regurgitation was not observed in the lacrimal sac compression test. Thus, the patient was diagnosed with primary canaliculitis on the basis of her clinical symptoms and laboratory findings.Interventions:Based on the diagnosis of primary canaliculitis, 1-snip punctoplasty and canalicular curettage were performed, and the patient was prescribed oral antibiotics for 2 weeks together with topical antibiotics for 4 weeks. Overall, the patient's symptoms improved after surgery, but epiphora and yellowish discharge from the lacrimal punctal orifice developed again 2 months after surgery during outpatient follow-up. Based on the diagnosis of recurrent primary canaliculitis, 4-snip punctoplasty and canalicular curettage were performed, and the patient was prescribed oral antibiotics for 2 weeks together with topical antibiotics for 4 weeks.Outcomes:Over a 6-month follow-up period, the symptoms disappeared completely and no other findings were observed.Lessons:Four-snip punctoplasty and canalicular curettage are simple clinical procedures that can minimize the recurrence rate of primary canaliculitis. Hence, 4-snip punctoplasty and canalicular curettage should be considered as the 1st-line treatment for primary canaliculitis and recurrent cases.

Canalicular Curettage to the Rescue: a report of three cases

“…Conservative therapy with warm compress, digital massage, topical and systemic antibiotics alone may not be effective in the presence of concretions and thick granular debris, necessitating the surgical intervention. Canalicular curettage with dilatation of punctum or various punctoplasty techniques (one-snip, two-snip, three-snip or four snip) to sufficiently widen the os helps to remove the stones, debris or concretions (Freedman et al, 2011;Kim & Ra, 2018;Lee et al, 2009). In our first case of recurrent canaliculitis (Case 1), one-snip punctoplasty was done to facilitate canalicular curettage.…”

“…Canalicular curettage is a surgical procedure used to remove canalicular contents and debris Sahu S et al Canalicular Curettage Nepal J Ophthalmol 2020;Vol 12 (24): [333][334][335][336][337][338] Canalicular curettage has been reported as an effective surgical option for primary and secondary canaliculitis (Freedman et al, 2011;Kaliki et al, 2012, Kim et al, 2015, for chronic, recurrent or recalcitrant canaliculitis (Pavilack & Freuh, 1992;Yaman et al, 2009;Kim & Ra, 2018;Alam et al, 2019) for canalicular pyogenic granulomas, papilloma, lymphoid hyperplasia after silicon punctual plugs or lacrimal stents (Hsu et al, 2001;Hsu 2002;Migliori 1990;Han et al, 2012).…”

Utility of 80‐MHz Ultrasound Biomicroscopy and Lacrimal Endoscopy in Chronic Lacrimal Canaliculitis

“…Lacrimal canaliculitis (LC) is a rare infection of the proximal lacrimal passage 1,2 . It accounts for approximately 1.4–2% of all lacrimal diseases and is prevalent among women as a result of hormonal changes 2,3 .…”

“…Lacrimal canaliculitis (LC) is a rare infection of the proximal lacrimal passage 1,2 . It accounts for approximately 1.4–2% of all lacrimal diseases and is prevalent among women as a result of hormonal changes 2,3 . The manifestations of LC commonly overlap with those of other diseases that occur around the lacrimal apparatus; thus, many cases are late diagnosed or misdiagnosed as chronic conjunctivitis, 4,5 chalazion, or chronic dacryocystitis, 2,6,7 causing insufficient or even incorrect treatment.…”

“…It accounts for approximately 1.4–2% of all lacrimal diseases and is prevalent among women as a result of hormonal changes 2,3 . The manifestations of LC commonly overlap with those of other diseases that occur around the lacrimal apparatus; thus, many cases are late diagnosed or misdiagnosed as chronic conjunctivitis, 4,5 chalazion, or chronic dacryocystitis, 2,6,7 causing insufficient or even incorrect treatment. Furthermore, traditional lacrimal system patency tests are not only invasive but also barely provide a clear and definite understanding of the pathological changes in the lacrimal passage, causing difficulties in terms of the differential diagnosis.…”