Long-term Follow-up of Canaliculotomies after Canaliculitis

Abstract

Background Canaliculitis is often misdiagnosed. There are several conservative and surgical treatment options.

Patients and Methods Retrospective analysis of 14 canaliculotomies in 10 patients with canaliculitis. The overall length of the surgically induced opening was measured and compared to the corresponding untreated lacrimal punctae. Lacrimal duct concrements were liberated and sent for microbiological and histological analysis. Patient satisfaction and relief of symptoms were documented as well as clinical findings.

Results Mean age was 59 ± 10 years (36 – 73 years) with balanced gender distribution. Mean follow-up time was 13 ± 8 months (4 – 27 months). Canaliculotomy was performed on 12 out of 14 inflamed canaliculi; in 2 cases, 3-snip punctoplasty was sufficient. The surgically induced length of the cuts was 1.7 ± 0.9 mm (0.4 – 3.7 mm). In 13 out of 14 cases, macroscopic concrements were found intraoperatively and actinomyces was verified histologically. Nine patients were free of symptoms postoperatively, and one patient manifested markedly less epiphora.

Conclusions The canaliculi remained open within the long-term follow-up period without any drawbacks to the lacrimal outflow. No recurrent infections were seen.

Zusammenfassung

Hintergrund Einerseits werden Kanalikulitiden sehr häufig übersehen, andererseits, bei korrekter Diagnosestellung, finden verschiedene konservative und chirurgische Behandlungsstrategien Anwendung.

Patienten und Methoden Retrospektive Studie von 14 Kanalikulotomien bei 10 Patienten mit Kanalikulitis. Die Eröffnungslänge der chirurgisch behandelten Canaliculi wurde gemessen und mit den unbehandelten, korrespondierenden Tränenpünktchen verglichen. Die aus den Tränenkanälchen geborgenen Konkremente wurden mikrobiologisch und histologisch untersucht. Die subjektiven wie objektiven Befunde der Patienten wurden erhoben.

Ergebnisse Das Durchschnittsalter der 5 Frauen und 5 Männer betrug 59 ± 10 Jahre (36 – 73 Jahre). Die durchschnittliche Follow-up-Zeit betrug 13 ± 8 Monate (4 – 27 Monate). Eine Kanalikulotomie wurde bei 12 der 14 entzündeten Tränenkanälchen durchgeführt; bei 2 Canaliculi war eine „3-Snip Punctoplasty“ ausreichend. Durchschnittlich wurden die Canaliculi 1,7 ± 0,9 mm (0,4 – 3,7 mm) chirurgisch erweitert. In 13 von 14 Fällen fanden sich intraoperativ Konkremente. Actinomyces konnte nur histologisch nachgewiesen werden. Neun Patienten waren postoperativ beschwerdefrei, 1 Patient litt unter verminderter Epiphora.

Schlussfolgerungen Die Canaliculi blieben postoperativ im Langzeitverlauf nach Kanalikulotomie offen. Der normale Tränenabfluss wurde nicht negativ beeinflusst. Es kam zu keinem Entzündungsrezidiv.

Key words

canaliculitis - canaliculotomy - epiphora - Actinomyces

Schlüsselwörter

Kanalikulitis - Kanalikulotomie - Epiphora - Actinomyces

• References

• 1 Vecsei VP, Huber-Spitzy V, Arocker-Mettinger E. et al. Canaliculitis: difficulties in diagnosis, differential diagnosis and comparison between conservative and surgical treatment. Ophthalmologica 1994; 208: 314-317
• 2 Kim UR, Wadwekar B, Prajna L. Primary canaliculitis: The incidence, clinical features, outcome and long-term epiphora after snip-punctoplasty and curettage. Saudi J Ophthalmol 2015; 29: 274-277
• 3 Freedman JR, Markert MS, Cohen AJ. Primary and secondary lacrimal canaliculitis: a review of literature. Surv Ophthalmol 2011; 56: 336-347
• 4 Kaliki S, Ali MJ, Honavar SG. et al. Primary canaliculitis: clinical features, microbiological profile, and management outcome. Ophthal Plast Reconstr Surg 2012; 28: 355-360
• 5 Hussain I, Bonshek RE, Loudon K. et al. Canalicular infection caused by Actinomyces. Eye (Lond) 1993; 7: 542-544
• 6 Lee MJ, Choung HK, Kim NJ. et al. One-snip punctoplasty and canalicular curettage through the punctum: a minimally invasive surgical procedure for primary canaliculitis. Ophthalmology 2009; 116: 2027-2030.e2
• 7 Pavilack MA, Frueh BR. Through curettage in the treatment of chronic canaliculitis. Arch Ophthalmol 1992; 110: 200-202
• 8 Anand S, Hollingworth K, Kumar V. et al. Canaliculitis: the incidence of long-term epiphora following canaliculotomy. Orbit 2004; 23: 19-26
• 9 Khu J, Mancini R. Punctum-sparing canaliculotomy for the treatment of canaliculitis. Ophthal Plast Reconstr Surg 2012; 28: 63-65
• 10 Perumal B, Meyer DR. Vertical canaliculotomy with retrograde expression of concretions for the treatment of canaliculitis. Ophthal Plast Reconstr Surg 2015; 31: 119-121
• 11 Law DZ, Goh ES. Incision-sparing management of canaliculitis: an efficacious alternative to surgical management. Can J Ophthalmol 2017; 52: 258-263
• 12 Mohan ER, Kabra S, Udhay P. et al. Intracanalicular antibiotics may obviate the need for surgical management of chronic suppurative canaliculitis. Indian J Ophthalmol 2008; 56: 338-340
• 13 Briscoe D, Edelstein E, Zacharopoulos I. et al. Actinomyces canaliculitis: diagnosis of a masquerading disease. Graefes Arch Clin Exp Ophthalmol 2004; 242: 682-686
• 14 Repp DJ, Burkat CN, Lucarelli MJ. Lacrimal excretory system concretions: canalicular and lacrimal sac. Ophthalmology 2009; 116: 2230-2235
• 15 Perry LJ, Jakobiec FA, Zakka FR. Bacterial and mucopeptide concretions of the lacrimal drainage system: an analysis of 30 cases. Ophthal Plast Reconstr Surg 2012; 28: 126-133
• 16 Perumal B, Carlson JA, Meyer DR. A pathological analysis of canaliculitis concretions: more than just Actinomyces. Scientifica (Cairo) 2016; 2016: 6313070