Lid/Orbit
Canaliculitis
Also known as: lacrimal canaliculus infection, punctum discharge, punctal pouting, Actinomyces canaliculitis, dacryocanaliculitis, lacrimal drainage infection, yellow granules punctum, chronic discharge medial canthus
Filed as: Soon
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Infection of the lacrimal canaliculus, most commonly caused by Actinomyces israelii. Characteristically presents with unilateral discharge from the punctum and a pouting, inflamed punctum with expressible concretions. Frequently misdiagnosed as conjunctivitis. Definitive treatment is surgical.
Recognition
Symptoms: what patients report
- Unilateral chronic or recurrent mucopurulent discharge from the inner corner of the eye.
- Mild redness and swelling of the medial eyelid and canalicular area.
- Watering (epiphora) due to partial canalicular obstruction.
- Low-grade discomfort or tenderness along the canaliculus.
- History of failed treatment for presumed recurrent conjunctivitis.
Signs: what the examination shows
- Pouting or gaping punctum — the punctum appears dilated and inflamed.
- Tender swelling along the course of the canaliculus (below the medial canthus).
- Expressible yellow, white, or gritty concretions from the punctum on gentle pressure — the hallmark sign.
- Surrounding mild conjunctival injection.
- Discharge that does not respond to topical antibiotics.
What OptoGuide™ covers for canaliculitis
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Canaliculitis — EyeWiki
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- The novel diagnostic value and characteristic imaging features of CT dacryocystography in primary lacrimal canaliculitis. Yang L, Yin Z, Sun H, et al. Scientific Reports. 2025;15(1):39049.
- Carcinomas of the Lacrimal Drainage System. Ramberg I, Toft PB, Heegaard S. Survey of Ophthalmology. 2020 Nov - Dec;65(6):691-707.
- Diagnostic utility of bony nasolacrimal duct area on computed tomography for differentiating malignant lacrimal tumors. Nagata J, Tanabe M, Seki E, et al. Graefe's Archive for Clinical and Experimental Ophthalmology = Al
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.