Canaliculotomy

Canaliculotomy is a surgical procedure that involves making an incision into one of the lacrimal canaliculi, the small passages that drain tears from the eye into the lacrimal sac. The procedure is primarily used to access the canalicular system in cases of disease or obstruction, particularly canaliculitis with concretions or calculi, to allow removal of material and restoration of drainage.

Indications for canaliculotomy include chronic canaliculitis presenting with tearing, discharge, lid margin inflammation, and the presence of canalicular stones or other concretions that block tear flow. It may also be performed to facilitate diagnosis or treatment when a foreign body or inflammatory debris is suspected within the canaliculus. In some cases, canaliculotomy is part of a broader surgical plan for canalicular repair or to prepare for subsequent procedures if obstruction persists.

The procedure is usually performed under local anesthesia. After dilating the punctum, a small incision or controlled entry into the canaliculus is created to expose the lumen. The obstructing material, stone, or concretions are carefully removed, and the canaliculus is irrigated to clear debris. The incision may be closed with fine sutures, or in some techniques the canaliculus is left to heal and may be supported with a temporary silicone stent to maintain patency during recovery. Postoperative antibiotics and anti-inflammatory medications are commonly prescribed.

Outcomes vary with the underlying condition and technique. Many patients experience relief of discharge and improved tear drainage, but recurrence of canaliculitis or stenosis can occur. If canalicular obstruction persists or recurs, additional procedures such as canaliculoplasty or more extensive lacrimal drainage surgeries (for example, dacryocystorhinostomy) may be considered.

Possible complications include punctal or canalicular stenosis, fistula formation, ongoing epiphora, infection, bleeding, or scarring that can affect tear drainage.