Treatment of Canaliculitis

This is Richard Allen at the University of Iowa.  This video demonstrates treatment of a right upper lid canaliculitis.  The patient has a history of irritation and discharge from the right eye.  Examination showed purulent material expressed from the right upper puntum.  A punctal sparing incision is then made medial to the punctum with an 11 blade in the area of the canaliculus.  Two cotton tipped applicators are used to express a stone from the canaliculus.  The stone should be examined to look for any foreign body.  It is sent to the pathologist for evaluation.  Additional material is expressed from the canaliculus consistent with a pyogenic granuloma.  Westcott scissors are used to further open the canaliculus medially to examine the area for a retained foreign body, as a retained punctal plug is the most common cause of canaliculitis in my experience.   A chalazion curette is used to further investigate the area.  A punctal dilator is used to ensure the punctum is patent.  The lacrimal system is then irrigated to ensure patency.  No type of stenting or repair is performed. Antibiotic ointment is used three times per day and the patient returns if the symptoms have not resolved.