Hidden in Plain Sight: The Diagnostic Challenges of Lacrimal Canaliculitis

Canaliculitis is an uncommon condition caused by chronic infection of the lacrimal canaliculus, a key part of the lacrimal drainage system. It is typically a unilateral condition and is associated with a variety of signs including discharge, epiphora, swelling of the eyelid and punctum pouting. Primary lacrimal canaliculitis (PLC) occurs mainly secondary to infection, most commonly due to actinomyces, staphylococcus, and streptococcus. Secondary canaliculitis, on the other hand, occurs as a complication of inter-canalicular or punctal plug insertion for the treatment of dry eye. Management can be conservative, with warm compress, topical and systemic antibiotics, irrigation, and syringing, or surgical, including punctoplasty, canaliculotomy, canalicular curettage, and silicone tube intubation.