Canaliculitis in Supernumerary Puncta and Canaliculi

Abstract

We report the first case of supernumerary puncta and canaliculi presented with canaliculitis. A-59 year-old gentleman presented with painful swelling of the left lower lid for a week, which was associated with epiphora. The swelling was confined to the nasal aspect of the left lower lid (0.5×0.5 mm) with inflamed overlying skin. Two puncta (0.5 mm apart) were noted. The outer punctum at the normal anatomical position was a cul-de-sac while the inner punctum it the caruncle was patent. We described the embryology leading to supernumerary puncta and canaliculi to explain the paradoxical patency of the abnormally located punctum as well as the pathomechanism leading to canaliculitis. The patient was treated with oral cloxacillin 500 mg, 6 hourly for 5 days; the cellulitis subsided after three days.

Punctal plug as a treatment option for dry eye associated with congenital supernumary puncta

“…Although the patient can be asymptomatic, various symptoms have been associated with double puncta including tearing and dacriocystitis due to duct obstruction and canaliculitis. [12467] In the current case, the patient had dry eye with a patent nasolacrimal duct similar to the case describe by Bair et al . [1]…”

“…[12] Similar to previous reports, our patient had the right lower eyelid affected and the accessory punctum had an accessory canaliculus that could lead into a common canaliculus or an independent canalicular opening in the lacrimal sac as previously described. [24]…”

“…A rare congenital anomaly of the lacrimal drainage system is a double lacrimal puncta which has rarely been reported in the literature. [1234] The majority of patients with this condition are asymptomatic or have unilateral epiphora in the affected eye. [12]…”

Supernumerary lacrimal puncta

“…Congenital anomalies can affect any part of the nasolacrimal system and a double punctum is thought to arise as an outbudding of the epithelial cord during embryogenic development. [ 2 ] Not achieving a complete separation of the cord from the epithelial surface can also be a reason for their development. [ 3 ] It is important to acknowledge that many terms are used to describe the accessory punctum including “supernumerary punctum” and “double punctum.”…”

“…[ 1 ] Furthermore, obstruction of the canaliculi causing canaliculitis has been reported. [ 2 ] In most reported cases, the accessory punctum had its own and separate canaliculus. We report two cases in which the two puncta (normal and accessory) shared the same canaliculus and this is rarely reported.…”