Infectious keratitis secondary to canaliculitis with concretions

Abstract

Rationale:Canaliculitis is a frequently overlooked and misdiagnosed disease. Concurrent corneal ulceration with canaliculitis is uncommon. We report such a case.Patient concerns:An 87-year-old woman complained of swelling and pain of the right eye after acute angle closure glaucoma attack. Slit-lamp examination was compatible with the features of infectious keratitis, and the cultures from corneal scrapings grew Streptococcus anginosus later. Hourly topical vancomycin (25 mg/ml) was instilled, then the corneal ulceration improved initially but became stationary after 1-week treatment.Diagnosis:Discharge from the upper punctum was noted subsequently and canalicular concretions were found through curettage. The cultures from canalicular discharge and concretions also revealed the presence of S. anginosus. Thus, infectious keratitis secondary to canaliculitis was diagnosed.Interventions:Canaliculotomy was performed to remove the large concretion and vancomycin was injected locally.Outcomes:The corneal ulceration resolved after canaliculitis was appropriately treated.Lessons:Canaliculitis could be a reservoir for organisms that may make compromised corneas liable to infections. Only the appropriate diagnosis and aggressive treatment of canaliculitis leads to the eradication of associated corneal infections.

Peripheral ulcerative keratitis secondary to chronic Citrobacter koseri canaliculitis

“…[ 16 ] Canaliculitis-induced corneal inflammation, lysis, and perforation, though reported previously, are also relatively rare. [ 18 ] Lacrimal system infections may resemble autoimmune disease-induced PUK as recently reported by Ishimoto et al . [ 19 ] The corneal lysis was thought to be due to an inflammatory reaction against toxin released by the pathogen.…”

Corneal Perforation Associated with Lacrimal Canaliculitis: A Case Series

“…In this report, all six patients with corneal perforation and lacrimal canaliculitis were female, and most of them were aged 70 years or above. Previous studies have reported two male cases and six female cases of corneal perforation associated with canalliculitis 13 , 14 , 16 , 17 It is possible that corneal perforation caused by lacrimal canaliculitis is much more common in females. A possible explanation is the preponderance of lacrimal duct diseases, including canaliculitis, in older females.…”

“… 21 , 22 In two cases of corneal ulcer associated with lacrimal canaliculitis, the same organism was isolated from the cultures of corneal scraping and canalicular discharge. 17 , 23 In another study of 35 patients with keratitis and nasolacrimal duct obstruction, the same organism was cultured from corneal scraping and mucopurulent material in the lacrimal sac. 24 In our case series, cultures of corneal scrapings at the perforation sites yielded no microorganisms, although most cultures of canalicular discharge were positive for bacteria or fungi.…”

Streptococcus constellatus-Induced Blindness in a 10-Year-Old Boy: A Case Report

“…These reports include orbital cellulitis with subperiosteal abscess, 9,10 endogenous endophthalmitis, 11,12 severe Lemierre syndrome with venous hypertension, and vasculitis that eventually causes blindness, 13 as well as infectious keratitis secondary to canaliculitis. 14 Cavernous sinus thrombosis is common during the infection. 10,15 The patient first presented to our clinic with the most obvious manifestation of left eye proptosis and ptosis.…”