Novel Therapy for Primary Canaliculitis

Abstract

In patients with primary canaliculitis, conservative medical therapy is associated with a high recurrence rate. Surgical treatments carry a great resolution rate but sometimes can result in the lacrimal pump dysfunction and canalicular scarring. The aim of this study is to introduce a minimally invasive approach, intracanalicular ophthalmic corticosteroid/antibiotic combination ointment infiltration (IOI, intracanalicular ointment infiltration), and to report our preliminary results for treating primary canaliculitis.In this retrospective, interventional case series, 68 consecutive patients with newly developed primary canaliculitis at a major tertiary eye center between January 2012 and January 2015. Thirty-six patients received conservative medical treatment alone (group 1; 36 eyes). Twenty-two patients and 10 medically uncontrolled patients from group 1 underwent IOI therapy (group 2; 32 eyes). Ten patients and 26 recurrent patients from group 1 and group 2 underwent surgery (group 3; 36 eyes). Patients were followed-up for at least 8 weeks. Clinical characteristics and outcomes were analyzed and compared.In this study, patients’ age, sex, onset location, and durations of disease among 3 groups showed no significant difference. The resolution rate in group 2 was 72.7% (16/22) for new patients and 68.8% (22/32) for gross patients, respectively, both of which are higher than that of group 1 (22.2%, 10/36) but lower than that of group 3 (100%, 36/36). Of group 3, 2 patients received 2 surgical interventions and resolved finally. Microbiological workup was available in 51 patients. The most common isolates were staphylococcus species (27.9%) and streptococcus species (20%). Canalicular laceration developed in 1 patient during the IOI procedure and 1 patient undergoing surgery. Only 2 had postoperative lacrimal pump dysfunction and 1 had canalicular scarring in group 3.The IOI may be an effective and minimally invasive technique for treating primary canaliculitis and obviate the need for further intensive surgery.

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

“…In most case reports, Actinomyces and Nocardia have been reported as the causative organisms of primary canaliculitis [5,7–9,15–17] ; however, recent reports have revealed that Staphylococcus and Streptococcus species are the most common causative organisms. [1,10,14,18] In the present case, the bacterial culture test could not identify the exact causative organism, but gram-positive rods were found. Additionally, the histologic examination identified tangled clumps of filamentous organisms, which are findings consistent with a diagnosis of sulfur granules.…”

“…Some studies have reported that medical management is somewhat effective for treating primary canaliculitis, but the frequency of recurrence may be high due to the fact that such management cannot completely eradicate the bacterial reservoir. [5,7–9,13,18] In particular, it has been reported that medical treatment can have a recurrence rate of 33% [11] ; furthermore, there have been many other reports of failed cases using medical treatment. [2,6,7,13]…”

Pediatric Canaliculitis: A Case Report

“…Canaliculitis appears at an average age of 60-65 years. 4,5 However, younger patients have also been reported. 6,7,8 When seen in infants and children, the clinician should be vigilant for other underlying lacrimal system pathologies.…”

“…The authors reported that although surgery was more effective, canalicular irrigation could reduce the need for surgery. 5…”

Comparing Efficacy of Punctum-incised Surgery versus Punctum- Sparing Surgery in Primary Canaliculitis Patients

“…Conservative treatment contains oral and topical antibiotics with corticosteroid. [3,4] Due to the special anatomic structure of lacrimal duct, conservative therapy may lead to persistence or recurrence compared with surgery. [5,6] A high recurrence rate from 33-92% of conservative therapy has been found in the previous researches.…”