The most common cause of canaliculitis is infection with Actinomyces israelii, a gram-positive bacillus with fine branching filaments, but other bacteria, fungi (eg, Candida albicans), and viruses (eg, herpes simplex) may be causative. An increasingly common cause of canaliculitis is a retained punctal plug (inserted as treatment for dry eyes) that has migrated into the canaliculus from the punctum.
Diagnosis is suspected based on symptoms and signs, expression of turbid secretions with pressure over the lacrimal sac and canaliculus, and a gritty sensation caused by necrotic material that can be felt during probing of the lacrimal system.
Canaliculitis can be differentiated from dacryocystitis. In canaliculitis, the punctum and canaliculus are red and swollen; in dacryocystitis, the punctum and canaliculus are normal, but a red, swollen, tender mass is located in or near the lacrimal sac.
Treatment of canaliculitis is warm compresses, irrigation of the canaliculus with antibiotic solution (by an ophthalmologist), and removal of any concretions or foreign bodies, which usually requires surgery (often done in the office with a local anesthetic). Antibiotic selection is usually empiric with a 1st-generation cephalosporin or penicillinase-resistant synthetic penicillin but may be guided by culture of irrigation samples.
Common causes of canaliculitis are infection or retained punctal plug.
Patients often have tearing, discharge, red eye (especially nasally), and mild tenderness over the involved side.
On examination, secretions may be expressed when pressure is applied to the lacrimal sac and canaliculus and a gritty sensation is felt by the patient when the lacrimal system is probed.
Treatment includes supportive measures, such as compresses, antibiotics, and sometimes surgery.