Dacryoendoscopic Features in a Case of Canaliculitis With Concretions

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Infectious canaliculitis is usually unilateral with microbiological profiles reflecting geographical variations. A female patient, aged 65 years, presented with left-sided discharge, epiphora, and reddish swelling of the inner side of the lower eyelid of 1-week duration. Clinical features were suggestive of an evolving lower canaliculitis. The left upper punctum and canaliculus and right lacrimal drainage systems were normal. A high definition dacryoendoscopic examination was performed (Fibertech, Japan), and it showed a grossly edematous mucosa of the vertical and horizontal canaliculus (Fig. A, B) with numerous concretions (Fig. A, C). There were focal areas of submucosal hemorrhages and fibrosis (Fig. A, B). The concretions were yellowish white in color and 2 types could be distinctly noted (Fig. A, C). The ill-defined types were a little large with fluffy borders, situated more toward the wall with intervening blood clots between them and the lumen (Fig. A–D, C2). The well-defined ones were smaller in size with distinct borders and situated centrally in the lumen of the canaliculus (Fig. A–D, C1). The patient was successfully treated with nonincisional canalicular curettage and topical antibiotics. Microbiological examination of the concretions revealed Staphylococcus aureus. Careful dacryoendoscopic examination could be useful for identifying the extent of the disease and potentially the response to various therapies.
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