Minimally invasive concretion-expulsion technique for primary canaliculitis: a prospective interventional study

Purpose: To introduce a minimally invasive concretion-expulsion technique for treating primary canaliculitis (PCC) that preserves the punctum and canalicular anatomy, establishing a novel therapeutic approach with improved efficacy. Materials and Methods: This prospective interventional study was conducted over a 36-month period (June 2020–June 2023), enrolling patients with PCC treated using the concretion-expulsion technique and followed for at least 12 months. The procedure involved gentle massage along the conjunctival aspect of the canaliculus to express concretions and secretions from the common canaliculus to the canalicular ampulla , followed by mechanical evacuation through the punctum. This process was repeated, with adjunctive gatifloxacin gel instillation to dislodge residual debris, until no secretions were visible. Tobramycin-dexamethasone ointment was then applied. Demographic data, clinical features, and outcomes were analyzed statistically. Results: Ninety patients (90 eyes) were included, with a male-to-female ratio of 22.2% (20) to 77.8% (70) and a mean age of 66.27±14.15 years. Laterality included 42 right (46.67%) and 48 left (53.33%) eyes, with involvement of the lower canaliculus in 57 cases (63.3%), upper canaliculus in 27 (30%), and both in 6 (6.7%). All patients exhibited increased ocular discharge, with common symptoms including redness(88.89%), epiphora ( 77.78%), swelling(55.55%), foreign body sensation ( 11.11%), and pain (6.67%). Concretions were present in 85 patients (94.44%), alongside signs such as mucopurulent discharge (44.44%), medial canthal swelling (38.89%), punctal eversion ("pouting",33.33%), conjunctival hyperemia (27.78%), canalicular dilation (22.22%), and obstruction (11.11%). The mean symptom duration was 16±11.06 months. A total of 66.67% were cured after one expulsion session, with a mean of 1.9±0.83 sessions required overall. Subgroup analyses (dry eye status, age <70 vs. ≥70 years, gender, symptom duration <15 vs. ≥15 months) revealed no significant differences in treatment frequency (P> 0.05 for all). Complete resolution of symptoms and clinical signs was observed in all patients by the final follow-up. Conclusion: The concretion-expulsion technique is a minimally invasive, safe, and effective approach that preserves the anatomical and functional integrity of the punctum and canaliculus. It represents a viable treatment option for primary canaliculitis.