Punctum-sparing canaliculotomy for the treatment of canaliculitis

Canaliculitis is an uncommon condition presenting with epiphora, medial eyelid swelling, pouting punctum, and punctal discharge. Surgical treatment with canaliculotomy with incision of the punctum is the treatment of choice when medical management fails. The risk of epiphora and functioning of the healed canaliculus is unknown. We describe a modification to the standard technique by leaving the punctum intact, incising the canaliculus along its full extent, and intubating the upper system with a silicone monocanalicular stent.

The lower punctum is dilated, and a Bowman probe inserted into the canaliculus. A no. 11 Bard-Parker blade is used to incise the canaliculus along its full extent, beginning 2 mm medial to the punctum, leaving the punctum intact. The contents of the canaliculus are curetted, and purulent material, drained. The wound is left open, and a mini-Monoka silicone monocanalicular stent (FCI Ophthalmics, Marshfield Hills, MA) is inserted to bridge the gap between the intact punctum and lacrimal sac. The incision is left to heal by secondary intention.

This modified punctum-sparing canaliculotomy was performed on 3 patients. In one patient, the upper and lower canaliculi were treated. The other 2 patients had involvement of the lower canaliculus only. All 3 patients tolerated the procedure well with full resolution of symptoms. No complaints of postoperative epiphora were made, and the system was patent to irrigation postoperatively.

Punctum-sparing canaliculotomy with monocanalicular intubation is an effective treatment for canaliculitis and may be particularly useful in cases in which both upper and lower canaliculi are involved and the risk of postoperative epiphora and canalicular scarring is unknown.