Dr.Bhagyesh Balasaheb Pore,Dr.Trivedi Nitin Vinaykant,Dr.Rohini Mankikar
TITLE
“ ACUTE CANALICULITIS” ON ALL COUNTS
FINANCIAL DISCLOSURE
WE HAVE NONE FINALCIAL DISCLOSURES TO BE MADE
INTRODUCTION
Acute canaliculitis – commonly misdiagnosed and wrongly treated.
Mimic Stye, FB Granuloma, Dacryocystitis.
SYMPTOMS
- Chronicity
- Absence of pain
- Epiphora
- Swelling at inner canthal area
- Mucopurulant discharge inspite of medical treatment
SIGNS
- Non tender
- Pouting punctum
- ROPLAS – ve
- Chronic Conjunctivits
- Expression of one or more concretions on pressure
Pathogenesis
Pathogens like Staphylococcus, Streptococcus and Actinomycesisraeli colonies in form of concretions resides in ampulla
Long term Use of punctal plugs
Early diagnosis and complete surgical curettage of ampulla is the crux of treatment.
AIM
Acute Lacrimal canaliculitis- ON ALL COUNTS
Clinical profile, microbiological profile & their influence on management outcomes.
Outline the correct management
Material and Methods
Prospective Interventional Case Series.
18 eyes of 18 patients treated for acute canaliculitis
Documentation From 2009 – 2013.
- Each subject posted for canaliculotomy till delivery of last concretion [ 2/3 snip procedure]
followed by curettage & systemic antibiotics
Steps of Canaliculotomy
- Local infiltrating anaesthesia
- Punctum dilated
- First snip on vertical segment of canaliculus
- Second snip on lid margin
- Third snip to excise triangle and thus completing canaliculotomy.
- CurettageWith chalazion clamp canaliculus is milked till last concretion gets delivered.Procedure contd..
- Diluted iodine solution applied with stick swab as an antiseptic.
- syringing attempted.
- Systemic antibiotic – amoxycilin and clavulanic acid
Outcome
RESULTS
Mean age at presentation- 36 yrs
Female predominance (66%).Vs Male 34%
Patients presented with common symptom of epiphora83%
Common sign of pouting punctum78%
Results contd..
12 (67%) lower canaliculus
03 (17%) upper canaliculus
03 (17%) had both canaliculi involved.
Mean delay in diagnosis of 15 months due to false impression.
RESULTS contd…..
Out of 16 (89%) culture positive specimens;
in 6(38%) Staphylococcus,
05 (32%) Streptococcus,
03 (19%) mixed organisms &
02 (17%) Actinomycesisraelli.
Results contd..
Syringing after 1 week-patent.
In 48 month follow up, no recurrence noted
CONCLUSION
- Awareness among treating eye surgeon regarding the entity is of utmost importance to diagnose canaliculitis.
- Microbiological profile plays crucial role in identifying pathogen and thereby delivering focused therapy.
- Also helpful from epidemiological point of view.
Conclusions contd…
procedures like canaliculotomy with curettage confer full resolution; without prevailing delay if diagnosed in time.
Leave a Comment