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What Is Lacrimal Canaliculitis?

Lacrimal canaliculitis is infection and inflammation of the lacrimal canaliculus, the small channel that carries tears from the punctum to the lacrimal sac. It is classically associated with Actinomyces species but can involve other bacteria or fungi. Patients often have chronic, unilateral redness, discharge, and tenderness near the punctum that mimic simple conjunctivitis. Because symptoms are mild but persistent, diagnosis is sometimes delayed. Removing concretions and treating infection are central to care.

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What Is Lacrimal Canaliculitis?

Lacrimal canaliculitis is infection and inflammation of the lacrimal canaliculus, the small channel that carries tears from the punctum to the lacrimal sac. It is classically associated with Actinomyces species but can involve other bacteria or fungi. Patients often have chronic, unilateral redness, discharge, and tenderness near the punctum that mimic simple conjunctivitis. Because symptoms are mild but persistent, diagnosis is sometimes delayed. Removing concretions and treating infection are central to care.

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Causes and Microbiology of Lacrimal Canaliculitis

Actinomyces israelii has long been recognized as a common organism, forming sulfur granule like concretions inside the canaliculus. Other gram positive and gram negative bacteria, as well as Candida or other fungi, can also be responsible. Obstruction, prior punctal plugs, and local trauma predispose to infection by trapping debris. Poor tear flow and chronic blepharitis may support microbial growth. Mixed infections and biofilm formation are not unusual in longstanding cases.

Clinical Features and Examination Findings

Typical findings include chronic, unilateral epiphora, mucous or mucopurulent discharge, and mild tenderness at the medial lid margin. The punctum may look pouting, red, or thickened. When the canaliculus is compressed, discharge or small yellowish concretions can extrude from the punctum. Conjunctival injection is usually localized near the inner canthus. Unlike acute dacryocystitis, canaliculitis often has less dramatic swelling and systemic symptoms, which contributes to misdiagnosis as simple conjunctivitis.

How Is Lacrimal Canaliculitis Diagnosed?

Diagnosis is based on the characteristic combination of chronic unilateral symptoms and exam findings at the punctum and canaliculus. The eye doctor may probe and irrigate the canaliculus, noting resistance or reflux of concretions. Expressed material can be sent for microbiologic analysis to guide antibiotic choice. Imaging is rarely required unless other lacrimal obstructions or masses are suspected. Recognizing canaliculitis avoids repeated, ineffective courses of topical drops aimed only at conjunctivitis.

How Is Lacrimal Canaliculitis Managed?

Definitive treatment usually involves canaliculotomy with curettage of concretions combined with appropriate antimicrobial therapy. Topical and sometimes oral antibiotics are chosen based on suspected or cultured organisms. In mild or early cases without large concretions, conservative management with warm compresses and topical drops is sometimes attempted, but recurrence is common if debris remains. Punctal plugs that contributed to blockage are removed. Follow up checks for resolution of discharge and patency of the drainage pathway.

FAQs About Lacrimal Canaliculitis

Why does my "conjunctivitis" keep coming back in one eye?

Recurrent, one sided redness and discharge often indicate a problem in the lacrimal drainage system rather than simple conjunctivitis. Canaliculitis is a frequent cause that requires more than routine drops.

Is lacrimal canaliculitis contagious?

The infection is usually localized, and casual contact does not often spread it. Good hygiene is still recommended, but the main issue is clearing the canaliculus rather than preventing person to person transmission.

Will antibiotics alone cure canaliculitis?

Antibiotics can improve symptoms, but if concretions remain inside the canaliculus, infection often returns. Mechanical removal through canaliculotomy and curettage is usually needed for durable cure.

Can canaliculitis damage my vision?

Canaliculitis rarely affects the cornea or retina directly. The main problems are chronic discomfort, discharge, and tearing. Prompt, definitive treatment restores comfort and tear drainage.