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Punctum-sparing canaliculotomy for the treatment of canaliculitis.
Ophthalmic Plast Reconstr Surg. 2012 Jan-Feb; 28(1):63-5.OP

Abstract

PURPOSE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Authors+Show Affiliations

Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9057, USA.No affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

22262291

Citation

Khu, James, and Ronald Mancini. "Punctum-sparing Canaliculotomy for the Treatment of Canaliculitis." Ophthalmic Plastic and Reconstructive Surgery, vol. 28, no. 1, 2012, pp. 63-5.
Khu J, Mancini R. Punctum-sparing canaliculotomy for the treatment of canaliculitis. Ophthalmic Plast Reconstr Surg. 2012;28(1):63-5.
Khu, J., & Mancini, R. (2012). Punctum-sparing canaliculotomy for the treatment of canaliculitis. Ophthalmic Plastic and Reconstructive Surgery, 28(1), 63-5. https://doi.org/10.1097/IOP.0b013e318244a367
Khu J, Mancini R. Punctum-sparing Canaliculotomy for the Treatment of Canaliculitis. Ophthalmic Plast Reconstr Surg. 2012 Jan-Feb;28(1):63-5. PubMed PMID: 22262291.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Punctum-sparing canaliculotomy for the treatment of canaliculitis. AU - Khu,James, AU - Mancini,Ronald, PY - 2012/1/21/entrez PY - 2012/1/21/pubmed PY - 2012/3/27/medline SP - 63 EP - 5 JF - Ophthalmic plastic and reconstructive surgery JO - Ophthalmic Plast Reconstr Surg VL - 28 IS - 1 N2 - PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SN - 1537-2677 UR - https://www.unboundmedicine.com/medline/citation/22262291/Punctum_sparing_canaliculotomy_for_the_treatment_of_canaliculitis_ L2 - http://dx.doi.org/10.1097/IOP.0b013e318244a367 DB - PRIME DP - Unbound Medicine ER -