Punctotomy augmented by the use of perforated punctal plugs for the management of canaliculitis

Abstract

Purpose The aim of this study was to evaluate the use of perforated punctal plugs with punctotomy for the management of canaliculitis with preservation of punctal and canalicular patency. Patients and methods This was a prospective interventional case series including 12 consecutive patients with unilateral canaliculitis. Punctotomy was performed for all cases with curettage of canalicular contents followed by application of a perforated punctal plug. Plugs were removed after 3 months and all patients were followed up for 6 months. Results This study included 12 cases of canaliculitis, eight female (66.7%) and four male (33.3%), with a mean age of 60.33 ± 4.6 years (ranging from 48 to 73 years). The lower canaliculus was affected in 83.33% of cases, whereas the upper canaliculus was affected in 16.67% of cases. Sulfur granules were present in six cases (50%) and six cases (50%) were negative. Gram staining of the expressed contents revealed the following: 50% Actinomyces israelii , 30% Staphylococcus aureus , and 20% mixed infection. Improvement in inflammation and epiphora occurred in 11 cases (91.67%), whereas persistence of epiphora occurred in one case (8.33%). One case (8.33%) showed inflammatory granuloma at the site of punctotomy and one case (8.33%) showed extrusion of the plug after 1 month of surgery. Conclusion This study showed that punctotomy combined with implantation of perforated punctal plug is an effective technique for the management of canaliculitis, with improvement in manifestations and preservation of punctal and canalicular patency.