Canalicular granuloma following recanalization by Sisler's trephine.

A 54-year-old male underwent a revision external dacryocystorhinostomy (DCR) along with lower canalicular recanalization using Sisler’s trephine (Beaver Visitec, Franklin Lakes, NJ, USA). Trephination was performed for a proximal (3 mm) partial obstruction. A bicanalicular Crawford stent (ISCON surgicals limited, Jodhpur, India) was placed and retained for 12 weeks. After stent removal, the Functional endoscopic Dye test (FEDT) showed free flow of dye in the ostium. A week following stent removal, patient presented with a mass protruding from the lower punctum. Examination revealed a 2 mm × 2 mm, pinkish mass with numerous surface vessels and a tapering end near the posterior wall of the vertical canaliculus (black star) suggesting its origin from the proximal canaliculus (Fig. 1, Panel A). Gentle displacement with a cotton tipped applicator revealed the punctum to be 360° free without any attachments to the mass (Fig. 1, Panel B). The mass was carefully excised at its tapering end followed by a course of topical steroids. At one year follow up, there was no recurrence and irrigation was patent.

Figure 1

Panel A shows a granuloma with surface vascularity arising from the canaliculus. Note the punctum (black star). Panel B shows the granuloma to be free from the punctum all around.

Comment

Demonstrable canalicular granuloma following trephination by Sisler’s trephine and intubation is rare and this case is of an educational value. Canalicular granulomas, papillomas and benign reactive lymphoid hyperplasia are reported following the use of punctal plugs for dry eye patients. Among these, pyogenic granulomas secondary to inappropriate sizing of punctal plugs were the most common. These have been successfully managed with excision and removal of punctal plugs.

Conflict of interest

The authors declared that there is no conflict of interest.