Canaliculitis is a rare disease of the lacrimal pathway, especially of the canaliculi. It is often not identified, therefore misdiagnosed and inadequately treated. It accounts 2 % of all lacrimal diseases. False diagnoses are usually conjunctivitis, blepharitis, dacryocystitis, hordeolum and chalazion. Besides viruses and fungi a variety of bacteria can cause a canaliculitis. Actinomyces is the most common pathogenic agent of canaliculitis. Its generic name was first described by Harz in 1877. In 1854 von Graefe as well as Kipp and others in 1883 identified actinomyces as the agent for intracanalicular dacryoliths. Although for years actinomyces has wrongly been attributed to ray fungi because of its filamentary and branched nature it actually belongs to facultative anaerobic, non-motile, non-spore-forming, non-acid-fast, pleomorphic bacilli. In the context of canaliculitis caused by actinomyces sulphur granules, also called plagues or actinomyces granules, can often be found in the affected canaliculi. Actinomyces can be identified by light microscopy, culture, biochemical and molecular biological procedures. The most appropriate treatment is to incise the lacrimal punctum, to perform a canaliculotomy and canalicular curettage and if necessary to perform a silicone intubation of the lacrimal system for prophylaxis of stenosis. A postoperative local therapy with a broad-spectrum antibiotic should be initiated for 1 - 2 weeks.

With the methods described here, it is now possible for the first time to perform surgery that obviates the need for a bypass procedure and maintains or restores the normal physiological function of the lacrimal system.

The dacryoendoscopy is a new important diagnostic development, which shows with help of better developed endoscopy-systems compared to previous systems a much better quality of the image and is therefore a valuable diagnostic help. Due to the check of the preoperative indication it is intraoperatively possible to confirm or, if needed, to change the indication after dacryoendoscopy. The laserdacryoplastic is an important new therapeutical development of the dacryoendoscopy and shows in suitable indications a comparable success-rate of conventional surgical interventions of the lacrimal drainage system. Therefore the possibility exists to carry out minimal invasive interventions of the lacrimal drainage.

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The history of the treatment of lacrimal duct stenosis dates back to the ancient world. Modern lacrimal duct surgery began with the description of external dacryocystorhinostomy (DCR) by Toti and the endonasal procedure by West. Modifications include construction of a mucous membrane flap and the use of different instruments such as microscopes, endoscopes, and laser. This article reviews the various methods currently in use, although the analysis makes clear how difficult it is to compare studies. Because of the high success rate and the possibility of correcting multiple disturbing factors of the lacrimal drainage system, external DCR remains the gold standard for the ophthalmologist; other methods must be measured by the success rate of external DCR. The future of lacrimal duct surgery lies in a better understanding of wound healing and thus the possibility for precise modulation. Better results may be possible by combining different surgical methods. Prospective studies are urgently necessary.