Corneal Perforation Associated with Lacrimal Canaliculitis: A Case Series

Abstract

Purpose To report seven eyes of six patients diagnosed with corneal perforation and lacrimal canaliculitis in a single facility. Methods Clinical records of patients with corneal perforation accompanied by lacrimal canaliculitis seen by the authors were reviewed. Results Six patients (7 eyes) with corneal perforation accompanied by lacrimal canaliculitis were identified. All patients were female, and all were treated with topical antibiotics while five were receiving topical corticosteroids. Two patients had a history of dacryocystitis and three had systemic immune diseases. The corneal lesions did not respond to topical antibiotics but were effectively treated by removal of concretions in the lacrimal canaliculi and lacrimal duct drainage together with conjunctival autograft or corneal transplantation. Conclusion Lacrimal canaliculitis is a risk factor for corneal perforation. When corneal perforation does not respond to antibiotics, lacrimal canaliculitis should be considered.

Lacrimal duct diseases are the potential cause of corneal epitheliopathy

“…Treatment of lacrimal drainage pathway disease combined with surgical intervention or contact lens wear for corneal perforation has shown favorable outcomes in patients with corneal ulcers and perforations. [7][8][9] Patients with lacrimal drainage pathway diseases exhibit elevated levels of various in ammatory cytokines in tear uid. [16][17][18] Recanalization of the lacrimal drainage pathway may reduce the levels of interleukins and matrix metalloproteinases.…”

“…These patients differ from patients with corneal ulcers and perforations associated with lacrimal duct obstruction, as those patients had systemic immune disorders such as rheumatoid arthritis and used topical corticosteroids. [6][7][8][9]12 The differences in patient background between corneal ulcers, perforations, and corneal epitheliopathy suggest that corneal epitheliopathy does not lead to the development of corneal ulcers or perforations, but rather each condition occurs independently in different groups of patients with tear duct disorders. In other words, corneal epitheliopathy may not be a precursor lesion to corneal ulcers or perforations.…”

“…The involvement of pathogens in the tear ducts and their roles in corneal ulcers and perforations have indeed been discussed in the literature. 14,15 Accumulating cases of corneal ulcers and perforations associated with lacrimal duct obstruction have revealed their characteristics [5][6][7][8][9]12 . In most cases, cellular in ltration was minimal at the site of ulcer and perforation, which is clearly different from infectious keratitis.…”

“…4 Recent years have seen an increase in reported cases of corneal ulcers and corneal perforations caused by lacrimal duct disorders. [5][6][7][8][9] These conditions may lead to treatment failure and severe visual impairment if left untreated. However, previous reports have also indicated that with early recognition of lacrimal duct disorders and appropriate treatment, the prognosis is generally favorable.…”