Canaliculitis: Too Often Underdiagnosed?

BACKGROUND: Canaliculitis is often mis- or underdiagnosed, leading to delayed and sometimes inadequate treatment.

PATIENTS AND METHODS: Thirteen patients with in total of 17 affected canaliculi were analysed. Collected data included demographic characteristics, the affected canaliculus (upper or lower, right or left), duration of symptoms until the correct diagnosis, and previous misdiagnoses and treatments. The objectives of this study were to determine the diagnostic delay and frequency of misdiagnosis, to identify characteristic clinical features, and to evaluate treatment outcomes following surgical management. Additionally, the presence of Actinomyces species in removed concretions from the canaliculi were histologically assessed.

RESULTS: The mean age was 61 ± 11 years (range 36 - 73 years). The mean duration of symptoms before correct diagnosis was 14 ± 13 months (range 1 - 48 months). All 17 affected canaliculi were treated surgically by canaliculotomy. At a mean follow-up of 12 ± 10 months (range 2 - 52 months), all canaliculotomies remained patent. Twelve of 13 patients (92%) were completely symptom-free, and no recurrence of canaliculitis occurred. In 15 out of 17 canaliculi, concretions were found intraoperatively. Histological examination identified Actinomyces species in 11 of 15 concretions (73%; 95% confidence interval, Wilson method: 48 - 89%), supporting their leading role as causative organisms of canaliculitis.

CONCLUSION: Canaliculitis remains a mis- or underdiagnosed condition despite its characteristic clinical presentation. Increased awareness and recognition of its typical signs are essential to avoid misdiagnosis and unnecessary treatments. Surgical canaliculotomies allow complete removal of bacterial concretions which are found in the canaliculi for the most part. Therefore, timely canaliculotomy should be regarded as the treatment of choice for this often-overlooked condition.