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Other Resources UpToDate PubMed


Contributors: Sid Schechet MD, D. Chimene Richa MD
Other Resources UpToDate PubMed


Canaliculitis is a rare chronic inflammation or infection of the lacrimal canaliculus. Etiologies include a canalicular foreign body (eg, punctual plug, dacryolith), canalicular diverticulum, or chemical stenotic obstruction such as from 5-fluorouracil or mitomycin-C. However, most cases are found to be idiopathic.

Canaliculitis can be caused by a bacterial, viral, or fungal pathogen. The most common pathogen is Actinomyces israelii (Streptothrix), an anaerobic filamentous gram-positive bacterium.

Patients typically present with chronic unilateral conjunctivitis, epiphora and/or mucopurulent discharge, lower eyelid erythema, and a red, pouting punctum. Canaliculitis is often mistaken for conjunctivitis, and patients describe being treated for months with topical antibiotics with no improvement.

Early diagnosis and prompt treatment with conservative therapies may lead to resolution without recurrence and without the need for invasive surgery.


H04.339 – Acute lacrimal canaliculitis of unspecified lacrimal passage
H04.429 – Chronic lacrimal canaliculitis of unspecified lacrimal passage

93129004 – Lacrimal canaliculus inflamed

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Dacryocystitis
  • Hordeolum and chalazion
  • Chronic Bacterial conjunctivitis
  • Migrated punctual plug
  • Lacrimal canalicular carcinoma (extremely rare)

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:05/25/2017
Last Updated:06/14/2018
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A medical illustration showing key findings of Canaliculitis : Eyelid edema, Unilateral distribution, Conjunctival injection, Excessive tearing
Clinical image of Canaliculitis - imageId=3520516. Click to open in gallery.  caption: 'Medial conjunctival injection, lower eyelid erythema, and a red, pouting punctum. '
Medial conjunctival injection, lower eyelid erythema, and a red, pouting punctum. 
Copyright © 2024 VisualDx®. All rights reserved.