Canaliculitis: Causes, Symptoms, Treatment, and Outlook
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick answer
Canaliculitis is inflammation of the canaliculi, the tiny channels that drain tears from the eyes to the nose, usually caused by a bacterial infection [1]. Symptoms include a red, painful eye, watery discharge and a swollen punctum [1]. It is more common in females and people over 40 [1]. Treatment includes antibiotics, warm compresses and massage, with outpatient surgery if needed [1].
What the research says
According to PubMed:
Adding a silicone tube during canaliculotomy prevented a common complication. In a randomized series of 47 patients with primary canaliculitis, canalicular obstruction after surgery occurred in 21.7% (5 of 23) of patients without a tube and in none of 24 patients with a tube, and anatomical success was 100% with a tube versus 78.3% without. (Wang et al., Current Eye Research, 2021 [7]).
Dry-eye plugs can raise the risk years later. In 25 dry-eye patients (42 eyes) followed for a median of 7.9 years after SmartPlug insertion, 6 patients (24%) developed canaliculitis, a median of 4.7 years after the plug was placed. (Klein-Theyer et al., British Journal of Ophthalmology, 2015 [8]).
Some cases improved without surgery. Among 201 patients with primary canaliculitis, 22 (10.9%) had Actinomyces infection, and repeated canalicular expression and irrigation with susceptible topical antibiotics achieved complete resolution in 86.4% of these patients. (Ding et al., European Journal of Ophthalmology, 2023 [9]).
What is canaliculitis?
Canaliculitis is inflammation of the small channels in your eye, called canaliculi. You have four canaliculi — two in each eye — and they help drain tears [1]. When these tiny channels become inflamed, your eye becomes red and painful with watery discharge, especially on the side nearest your nose [1].
Who does it affect, and how common is it?
Canaliculitis isn't common. About 2% to 4% of conditions affecting the tear system are canaliculitis [1].
What are the symptoms of canaliculitis?
When one canaliculus or both canaliculi become infected or injured, canaliculitis may develop. Canaliculitis symptoms include cloudy fluid that drains from your eye (discharge), eye pain, hard stone-like bumps in your canaliculi, red eye, swollen punctum, watery eyes (epiphora), and skin discoloration around your eyelids [1].
Symptom | What to look for |
|---|---|
Cloudy discharge | Fluid draining from the eye |
Eye pain | Aching or soreness in the eye |
Hard, stone-like bumps | Small lumps inside the canaliculi |
Red eye | Redness, especially near the nose side |
Swollen punctum | The tear-drain opening looks puffy ("pouting punctum") |
Watery eyes (epiphora) | Eyes water excessively |
Skin discoloration | Color changes around the eyelids |
What causes canaliculitis?
Infection with Actinomyces israelii bacteria typically causes canaliculitis [1] [2]. But canaliculitis symptoms may also develop when canaliculi become infected with fungi, other bacteria, or viruses [1].
Can dry-eye plugs cause it?
Sometimes, silicone plugs inserted into your punctum to treat dry eyes can become loose. These plugs may travel into your canaliculi and cause inflammation [1]. A plug or other object lodged in your canaliculi may increase your likelihood of developing an infection [1].
Can injury cause canaliculitis?
Inflammation can develop after eye injuries when your canaliculi experience trauma [1]. Severe eye injury may result in a cut to your canaliculus, known as a canalicular laceration. When this occurs, eye surgeons perform canalicular laceration repair [1] [3].
Does canaliculitis affect vision? Is it contagious?
Typically, canaliculitis won't affect your vision permanently [1]. But the condition causes symptoms like swelling and watery eyes that may temporarily affect how well you see [1]. Talk to your healthcare provider if you develop canaliculitis symptoms.
No — canaliculitis isn't contagious [1].
How do providers diagnose canaliculitis?
If you have symptoms, see an eye care specialist called an ophthalmologist. This provider thoroughly examines your eyes, talks with you about your symptoms, and looks for redness and upper punctum swelling, known as a pouting punctum [1] [2]. Your provider may press on your punctum or near your canaliculi to see if discharge drains from your eye [1].
Your provider does an exam (clinical evaluation) to check your symptoms and asks about them to make a differential diagnosis — figuring out all the conditions that may cause your symptoms. Other conditions that may cause pain, redness, and watery eyes include blepharitis, pink eye (conjunctivitis), and stye [1].
Your provider may take a sample of eye discharge to examine under a microscope to determine if you have a bacterial infection [1].
Condition | Shared symptoms | Why it can be confused |
|---|---|---|
Canaliculitis | Pain, redness, watery eyes | Hard bumps and inner-corner swelling give it away |
Blepharitis | Red, irritated eyes | Eyelid inflammation without the stone-like bumps |
Pink eye (conjunctivitis) | Redness, watering, discharge | Discharge but no hard plugs in the canaliculi |
Stye | Red, painful eyelid lump | Lump on the eyelid edge rather than in the tear channel |
How is canaliculitis treated?
Antibiotics can get rid of the bacterial infection. Your healthcare provider may prescribe oral antibiotics, antibiotic creams, or antibiotic eye drops [1]. Providers may also flush (irrigate) your eyes with an antibiotic solution [1].
Are there at-home treatments?
Canaliculitis home remedies include putting a warm compress on your eyes. Your provider may recommend using a warm washcloth to gently heat the area and reduce swelling [1]. They may also recommend gently massaging the area [1] [2].
Treatment level | What it involves |
|---|---|
Prescription medication | Oral antibiotics, antibiotic creams, or eye drops; eye irrigation with antibiotic solution |
At-home care | Warm compress with a warm washcloth to heat the area and reduce swelling; gentle massage |
Outpatient surgery | Canaliculotomy — removes lodged objects; may insert a tiny stent tube to help tears drain; incision left open to heal or closed with stitches |
Follow-up | Stent typically removed in-office after a few months |
Will I need surgery?
If you develop canaliculitis suddenly — known as acute canaliculitis — you may have treatment with antibiotics, compresses, and massage. If those treatments don't work, providers can remove objects lodged in your canaliculi during outpatient surgery called canaliculotomy [1] [2].
Your provider may insert a tiny tube, called a stent, during surgery to help tears drain [1]. They may leave the incision open while the area heals, or you may have stitches [1].
What is recovery like after surgery?
Your incision heals during recovery after canaliculitis surgery. If you have a stent, your provider typically removes it after a few months during an in-office procedure [1].
Are there complications?
Canaliculitis can be challenging to diagnose and treat [1] [6]. Without prompt treatment, the condition may last for a long time (chronic canaliculitis), and sometimes infection may recur [1]. Some people who have canaliculitis surgery experience scarring [1].
How can I reduce my risk of canaliculitis?
A bacterial infection is the most common cause of canaliculitis [1]. You can help protect yourself from infection if you avoid touching your eyes, clean or change your contact lenses regularly, discard eye makeup after a few months (or immediately after having an eye infection), and wash your hands [1].
Canaliculitis can happen to anyone. But you may be at higher risk if you've had punctal plugs inserted to treat dry eyes [1] [2]. Contact your healthcare provider if you notice any eye symptoms like redness, pain, or watering.
When should I see my healthcare provider?
Call your healthcare provider if you experience red or swollen eyes or if your eyes water a lot, if you notice any new symptoms, or if your symptoms get worse [1]. Follow your provider's instructions for how to manage canaliculitis at home.
Outlook: What can I expect?
Canaliculitis may take time to resolve [1]. Be sure to take all medications and use creams and eye drops exactly as your provider instructs [1].
Canaliculitis is curable, but it's important to seek treatment early for the best health outcome [1]. Contact your healthcare provider if you have symptoms.
Conclusion
Canaliculitis is a rare but very treatable condition affecting the tiny tear-draining channels in the inner corner of your eye. If you have red, painful, watery eyes with hard stone-like bumps near your nose, see an ophthalmologist early — antibiotics, warm compresses, and massage usually clear it up, and the condition is curable. Taking your full course of medication and acting promptly prevents it from becoming a stubborn, recurring problem.
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Frequently Asked Questions
What is canaliculitis?
Canaliculitis is inflammation of the canaliculi — the four tiny channels (two in each eye) that drain tears from your eyes to your nose.
What causes canaliculitis?
Canaliculitis most often follows a bacterial infection with Actinomyces israelii. Fungi, other bacteria, and viruses can also cause it, and loose dry-eye plugs or eye injuries can trigger inflammation in the canaliculi.
What are the symptoms of canaliculitis?
A red, painful eye with watery discharge (especially near the nose side), hard stone-like bumps in the canaliculi, a swollen punctum, cloudy discharge, and skin discoloration around the eyelids.
Is canaliculitis contagious?
No, canaliculitis isn't contagious.
Who is most likely to get canaliculitis?
Anyone can get it, but it's more common in females and people over age 40. People with punctal plugs for dry eyes are at higher risk.
How common is canaliculitis?
Canaliculitis is uncommon — about 2% to 4% of conditions affecting the tear system are canaliculitis.
Can canaliculitis affect my vision?
Typically not permanently. Swelling and watery eyes may temporarily affect how well you see, but the condition itself usually doesn't cause lasting vision damage.
What are "pouting punctum" and "epiphora"?
A pouting punctum is a swollen tear-drain opening at the inner eye corner. Epiphora means watery eyes — excessive tearing.
How is canaliculitis diagnosed?
An ophthalmologist examines your eye, looks for redness and a swollen punctum, may press near the canaliculi to check for draining discharge, and can examine a discharge sample under a microscope.
How is canaliculitis treated?
Oral antibiotics, antibiotic creams or eye drops, eye irrigation with antibiotic solution, warm compresses, and gentle massage. If these fail, outpatient surgery called canaliculotomy removes lodged objects.
What is canaliculotomy surgery?
An outpatient procedure that removes objects lodged in the canaliculi. The surgeon may insert a small stent tube to help tears drain and may leave the incision open to heal or close it with stitches.
How do I recover after canaliculitis surgery?
The incision heals during recovery. If a stent was placed, your provider typically removes it after a few months during an in-office visit.
Can canaliculitis come back?
Yes — without prompt treatment it can become chronic or recur. Some people also develop scarring after surgery.
How can I prevent canaliculitis?
Avoid touching your eyes, clean or change contact lenses regularly, discard eye makeup after a few months (or right after an eye infection), and wash your hands.
Is canaliculitis curable?
Yes — it's curable, and early treatment gives the best outcome. If your eye is red, painful, or watering, contact a provider promptly.
This article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions about a medical condition. Never disregard professional medical advice or delay seeking care because of something you have read here.
Related Reading
Dacryocystitis: What It Is, Symptoms, Causes, Diagnosis, Treatment and Outlook — What You Need to Know explains infection of the tear sac just below the canaliculi.
Blocked Tear Duct (Nasolacrimal Duct Obstruction): Symptoms, Causes, and Treatment explains blocked tear drainage and how it is opened.
Actinomycosis: What It Is, Why It Develops, and How It Is Treated explains the bacteria that cause many canaliculitis cases.
Epiphora (Watery Eyes): Causes, Diagnosis, and Treatment — A Complete Guide explains constant watery eyes and their common causes.
References
Cleveland Clinic. Canaliculitis: What It Is, Causes & Treatment. Cleveland Clinic. Last updated November 2, 2022. https://my.clevelandclinic.org/health/diseases/24412-canaliculitis
American Academy of Ophthalmology. Canaliculitis. EyeWiki. Reviewed (Up to Date) July 23, 2026. https://eyewiki.aao.org/Canaliculitis
American Academy of Ophthalmology. Canalicular Laceration (Trauma). EyeWiki. Reviewed (Up to Date) July 8, 2026. https://eyewiki.aao.org/Canalicular_Laceration_(Trauma)
Allen RC. Canaliculitis. Merck Manual Consumer Version. Last updated January 2026. https://www.merckmanuals.com/home/eye-disorders/eyelid-and-tearing-disorders/canaliculitis
Feroze KB, Patel BC. Canaliculitis. Updated July 31, 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. PMID 28722951. https://www.ncbi.nlm.nih.gov/books/NBK441922/
Zaveri J, et al. Lacrimal canaliculitis. Saudi J Ophthalmol. 2014;28(1):3-5. PMID: 24526851. https://doi.org/10.1016/j.sjopt.2013.11.003
Wang M, et al. Outcomes of canaliculotomy with and without silicone tube intubation in management of primary canaliculitis. Curr Eye Res. 2021;46(12):1812-1815. PMID: 34275398. https://doi.org/10.1080/02713683.2021.1942074
Klein-Theyer A, et al. Prevalence of canaliculitis after SmartPlug insertion during long-term follow-up. Br J Ophthalmol. 2015;99(8):1134-6. PMID: 25722494. https://doi.org/10.1136/bjophthalmol-2014-306290
Ding J, et al. Actinomycotic primary canaliculitis: predisposing factors, clinical characteristics, and treatment outcomes. Eur J Ophthalmol. 2023;33(6):2194-2200. PMID: 36927124. https://doi.org/10.1177/11206721231163612
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