Clinical features, microbiological profiles and treatment outcome of lacrimal plug-related canaliculitis compared with those of primary canaliculitis

Abstract

In comparison with primary canaliculitis, plug-related canaliculitis appear to be more prevalent in women and show a different microbiological profile. Retrieval of infected plug by canaliculotomy and adequate antibiotics can achieve a good outcome. Long-term follow-up is required because canaliculitis may develop several years after plug insertion.

Punctal granuloma as a manifestation of intracanalicular plug‐related canaliculitis

“…Removal of all infected lacrimal plugs and associated pyogenic granuloma or concretions can prevent recurrence of canaliculitis. In a previous study by the authors of 13 patients with plug‐related canaliculitis who underwent canaliculotomy to remove infected plugs, only two had recurrent dry eye requiring lubricant medications and none needed lacrimal plug re‐insertion . Decreased dependence of lubricants in these patients may be related to less tear drainage caused by decreased pumping function after canaliculotomy.…”

“…Lacrimal plugs offer lasting effect and reversibility. However, various complications associated with lacrimal plugs insertion have been reported, including plug extrusion or migration, epiphora, conjunctival erosion, dacryocystitis, canaliculitis and pyogenic granuloma formation …”

“…There are many kinds of plugs available on the market including punctal, canalicular, temporary and permanent types . Plugs loss was the most commonly reported problem with punctal plugs and canaliculitis was the most commonly seen complication for intracanalicular plugs . In a study of patients who underwent SmartPlug insertion with median follow‐up time of 7.9 years (range 5.6–10.5 years), the prevalence of canaliculitis per patient was 24 per cent and the prevalence of canaliculitis per SmartPlug was 16.6 per cent .…”

“…Both primary canaliculitis and plug‐related canaliculitis usually present with irritation, tearing, increased discharge, granuloma formation and congested bulbar conjunctiva, which cause canaliculitis to be often overlooked and misdiagnosed as conjunctivitis, chalazion or tumour, leading to delay in effective therapy . Unlike ordinary conjunctivitis, pouting punctum with discharge refractory to topical antibiotic eye‐drops treatment alone can often be observed in canaliculitis.…”

“…In Australia, the USA and other countries, lacrimal plug insertion can be performed by optometrists. Despite the lasting effect and reversibility of lacrimal plugs in treating dry eye, various complications have been reported in the literature . Plug‐related canaliculitis – one of the important complications – is often misdiagnosed, or diagnosed late, because it can mimic many other common ocular clinical manifestations.…”