Canaliculotomy is a surgical procedure to correct canaliculitis, a condition characterized by medial eyelid edema, epiphora (excessive tearing), punctal discharge, and pouting punctum (sharp tip). It deals with conditions affecting tear duct function such as infection, blocked tear ducts, abnormal growth, structural problems, and others. The tear ducts or canals (the canaliculus) are situated in the eyelid, in the eye's corner. The canaliculus consists of two ducts, the superior and inferior ducts, and a sphincter regulating tear release. The procedure involves draining blocked tear ducts.
Canaliculotomy is thought to be the treatment of choice or standard treatment for epiphora when medical management fails. Medical management initially helps to clear the infection, but frequent recurrences necessitate surgical intervention. Canaliculotomy was said to have more risks and complications which led to the development of other procedures such as the modification of the canaliculotomy standard technique that does not interfere with the punctum. Another technique involves combining canaliculotomy with a canalicular curettage. A retrograde canaliculotomy together with punctoplasty is yet another procedure performed to reconstruct the canaliculi and puncta.
Preparation & Expectation Before Surgery
A canaliculotomy is an outpatient procedure, and the patient is advised to have an adult drive them back home. Because canaliculitis is a rare condition, it is often misdiagnosed as chalazion, dacryocystitis, chronic blepharitis, and chronic conjunctivitis. Therefore, the patient should expect extensive tests that include collection of demographic data, clinical evaluation, and microbiological examinations. For those with discharge or concretions, the doctor may send mucopurulent discharges to the laboratory for examination before the procedure. Diagnostic tools used to confirm the disease include Dacryocystography and ultrasound biomicroscopy.
Types, Purpose & Procedure
The patient will be under local or general anesthesia. The doctor may also opt for sedation and will place the patient in a supine position.
The different types of procedures include:
Canaliculotomy where the surgeon:
- Makes an incision on the side of the nose and removes the bone positioned at the center of the tear sac and nose.
- Attaches the lining of the tear sac to the nose’s lining to create drainage for tears.
- Closes the incision using sutures.
Canalicular Curette with Canaliculotomy
Patients with chronic discharge or concretions and canaliculitis can have this procedure.
- Makes an incision along the length of the lower lid’s canaliculus using Wescott scissors
- Uses cotton tip applicators to express the stone or concretion in the canaliculus
- Uses a chalazion curette to clear the inside of the canaliculus of any additional material
- Also incises the canaliculus along the punctum on the upper eyelid using the Wescott scissors blade. S/he then uses cotton tip applicators to express the stone.
- Checks the stone for a foreign body and sends it to the pathologist for examination. The stone may be examined for a punctal plug to relieve the patients of symptoms.
- May extend the incision to examine if a foreign body was retained
- Performs punctal dilation and lacrimal irrigation to ensure patency (no obstruction)
- May opt not to close the incision with sutures
- Dilates the lower punctum
- Inserts a Bowman probe into the canaliculus
- Uses a no. 11 Bard-Parker blade to make an incision into the canaliculus, along its full length. This action leaves the punctum intact.
- Curettes the contents of the canaliculus and drains the purulent material
- Leaves the wound open and inserts a mini-Monoka silicone monocanalicular stent. The stent helps to close the gap between the lacrimal sac and intact punctum. Patients who do not want a scar can have a tube inserted in the inner corner of the eye leading to the nose. This tube serves as a tent that facilitates the proper draining of tears. The tube is removed two months following surgery.
- Leaves the wound to heal by secondary intention
Risks, Side Effects & Complications
Risks and complications of canaliculotomy include:
- Fistula formation
- Eyelid thickening
- Excessive bleeding
- Severe nose bleeding
- Scarring of the tear ducts or canals
- Dilation of the punctum or canaliculi
- Lacrimal pump failure or dysfunction
- Narrowing or strictures of canaliculus
- Recurrent disease if concretions remain
- Excessive tearing or post-operative epiphora
- Canaliculus fibrosis due to recurrent inflammation
- Since the curette has sharp edges, it can damage the canaliculus’ lining
- Scarring of the lacrimal sac and side of the nose. This can be immediate or occur years after the procedure necessitating further surgical correction.
After Care, Recovery & Outcome
The patient is given topical antibiotic eye drops for two weeks. Sutures are removed after one week following surgery. A raised scar may form in the surgery site, but it should clear after several months. Follow-up visits are scheduled in the first, third, sixth, and 12th weeks following the procedure.
A canaliculotomy is a safe and effective technique that enables a patient to have a clear vision without symptoms once healing has taken place.