To highlight canaliculitis masquerading as chronic dacryocystitis that may mislead a rhinologist.

Canaliculitis is an inflammation of the lacrimal canaliculi caused by infection or as a complication of punctal plug insertion. It is often misdiagnosed, leading to a delay in diagnosis.

We report a case of a 20-year-old female patient who presented with complaints of watering from left eye since 1 year and was referred to the Department of Ear, Nose, and Throat for endoscopic dacryocystorhinostomy (DCR). She had a history of silicone punctal plug insertion in the same eye for “dry eye” following an attack of herpes zoster 12 years earlier. She was asymptomatic for 10 years following punctal plug insertion, but started complaining of epiphora since the last 2 years. Punctal plug was removed 1 year back by an ophthalmologist but the epiphora persisted. Regurgitation of purulent discharge on pressure over lacrimal sac area made it look like dacryocystitis. Syringing through lower punctum was blocked while through the upper punctum it was patent. Thus, possibility of nasolacrimal duct block was ruled out. An occuloplasty opinion was sought and a diagnosis of lower canaliculitis with possibility of retained plug was made.

Canaliculitis should be considered as a differential diagnosis in cases presenting with epiphora as canaliculitis is a close masquerade of dacryocystitis.

As more and more rhinologists are getting direct referrals of cases needing endoscopic DCRs, it is important for them to be well aware of other associated pathologies of proximal lacrimal system. This will help them to reach a correct diagnosis before going ahead with endoscopic DCR.

Gupta N, Das S, Chawla N. Canaliculitis masquerading as Dacryocystitis: Rhinologist's Dilemma. Clin Rhinol An Int J 2017;10(2):91-92.