ConditionEyes & vision
Canaliculitis
Canaliculitis is an infection or inflammation of the lacrimal canaliculus, the tiny channel that drains tears from the inner corner of the eyelid toward the nose. It causes a red, swollen, pouting tear duct opening, a watery eye and discharge that may contain gritty yellow "stones". It is uncommon and often misdiagnosed as recurrent conjunctivitis. The usual cause is Actinomyces bacteria, and lasting cure usually needs a minor procedure to clear the canal, not just antibiotic drops.
Also called: Lacrimal canaliculitis, infection of the tear canal, canalicular infection
At a glance
- What it is
- Infection of the small tear drainage channel in the upper or lower eyelid near the nose.
- Typical cause
- Actinomyces bacteria; also staphylococci, streptococci, fungi and herpes virus.
- Signs
- Swollen inner lid margin, red pouting tear duct opening, discharge, watery eye, gritty concretions.
- Often confused with
- Chronic conjunctivitis, which responds to drops while canaliculitis keeps returning.
- Treatment
- Warm compresses, massage and antibiotics; usually curettage or canaliculotomy to remove concretions.
When to get help
See a doctor within a day or two
- Painful, red swelling spreading across the eyelid or to the cheek, or fever
- A tender swelling beside the nose below the inner corner of the eye (possible dacryocystitis)
- Reduced vision, eye pain with light sensitivity, or pain moving the eye
Book a routine appointment
- Watery, sticky eye that keeps coming back after "conjunctivitis" drops
- Swelling and redness at the inner corner of one eyelid
- Pus or gritty material expressed from the tear duct opening when pressing nearby
- Persistent watering after a punctal plug was inserted
What the canaliculi do
Tears drain from the eye through two small openings on the inner edge of the upper and lower eyelids, the puncta. From there, each runs into a narrow channel, the canaliculus, about 10 mm long. The two canaliculi join and empty into the lacrimal sac beside the nose, which drains into the nose through the nasolacrimal duct.
In canaliculitis, one canaliculus (most often the lower) becomes infected and inflamed, and its opening may bulge.
Causes
- Actinomyces israelii and related bacteria: the most common cause. They form sulfur-like granules or "stones" (concretions) inside the canal that shelter bacteria from antibiotics.
- Other bacteria: Staphylococcus, Streptococcus, Propionibacterium, Nocardia.
- Fungi such as Candida and Aspergillus.
- Viruses, especially herpes simplex and varicella-zoster.
Risk factors
- punctal plugs, small devices placed in tear duct openings to treat dry eye, especially intracanalicular plugs that migrate
- older age and women, who are more often affected
- previous tear duct procedures
- chronic blepharitis and eyelid inflammation
Symptoms
- persistent watering of one eye
- discharge, often sticky or mucopurulent, that keeps returning
- redness and swelling at the inner corner of the eyelid
- a pouting, enlarged, red punctum
- yellow, gritty material that can be expressed from the punctum with gentle pressure (a key sign)
- mild tenderness
- red eye on the inner side (conjunctivitis-like)
Pain is usually mild. Vision is not affected.
Canaliculitis vs similar conditions
| Condition | Location | Distinguishing features |
|---|---|---|
| Canaliculitis | Inner eyelid margin, along the canal | Pouting punctum, expressible concretions, chronic course |
| Dacryocystitis | Lacrimal sac beside the nose, below the inner corner | Tender swelling below the corner of the eye, often acute |
| Conjunctivitis | Whole eye surface | Both eyes often affected, responds to treatment |
| Chalazion or stye | Eyelid gland | Lump within the lid, not at the punctum |
Diagnosis
An eye doctor examines the eyelids under a slit lamp microscope. Pressing gently along the canaliculus may express pus or concretions from the punctum, which is nearly diagnostic. The discharge can be sent for culture. A dilated punctum and a "pouting" appearance support the diagnosis. Irrigation of the tear duct is usually patent (fluid passes into the nose), which helps distinguish it from a blocked nasolacrimal duct.
Treatment
Conservative treatment
- Warm compresses several times a day
- Massage along the canaliculus toward the punctum to express material
- Antibiotic or antifungal drops, chosen according to the organism, sometimes with irrigation of the canal with an antibiotic solution
- Oral antibiotics in some cases
- Removing a punctal plug if one is present
Medical treatment alone often fails or the infection recurs, because concretions protect the bacteria.
Procedures
- Canalicular curettage: under local anesthetic, the doctor dilates the punctum and scrapes out the concretions with a small curette. Often curative.
- Punctoplasty or canaliculotomy: a small incision opens the punctum or canal to remove all material. The canal usually heals well.
- Plug removal if a migrated intracanalicular plug is the cause.
Complications
- chronic or recurrent infection
- scarring and narrowing of the canal, leading to permanent watery eye
- spread to the lacrimal sac or eyelid
Outlook
With removal of concretions, most people are cured. Recurrence is uncommon after complete clearance. Persistent watering after treatment may need further tear duct surgery.
Frequently asked questions
What is canaliculitis?
Canaliculitis is an infection of the canaliculus, the narrow channel that carries tears from the inner corner of the eyelid to the tear sac. It causes a watery, sticky eye and a swollen, red tear duct opening. It is often caused by Actinomyces bacteria that form gritty stones in the canal.
Why does my "conjunctivitis" keep coming back?
A sticky, watery eye on one side that keeps returning after antibiotic drops can be canaliculitis, a blocked tear duct, or blepharitis rather than conjunctivitis. An eye doctor can check the tear duct openings and express any trapped material.
Do antibiotic drops cure canaliculitis?
Not usually on their own. Drops may improve symptoms temporarily, but bacteria shelter inside concretions in the canal. Removing these with curettage or a small incision is often needed for a lasting cure.
Can punctal plugs cause canaliculitis?
Yes. Punctal plugs, used to treat dry eye, can harbor bacteria, especially plugs placed within the canal that move deeper. Removing the plug and treating the infection usually resolves it.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology EyeWiki: Canaliculitis
- American Academy of Ophthalmology: Blocked tear duct
- American Society of Ophthalmic Plastic and Reconstructive Surgery: Tear duct problems
- Merck Manual Professional Version: Lacrimal disorders
- MedlinePlus: Blocked tear duct