Which of the following best describes canaliculitis treatment?

• A. Express contents in the canaliculus in office, warm compress followed by massage bid, doxycycline 100 mg bid for 1-2 weeks, and moxifloxacin 0.5% qid for 1-2 weeks
• B. Observe without therapy
• C. Only topical antibiotic drops
• D. Immediate surgical removal

Answer: (A)

canaliculitis should be treated by both physically removing the infectious material and by targeted antimicrobial therapy. Expressing the contents of the canaliculus in the office helps decompress the duct, clears the accumulated material, and reduces the source of infection. Warm compresses and gentle massage aid this drainage and help prevent blockage from recurring concretions. Because Actinomyces and persistent infection are common in canaliculitis, adding systemic antibiotics such as doxycycline helps address organisms that inhabit biofilms and provides anti-inflammatory benefit, while a concurrent topical antibiotic like moxifloxacin covers the canalicular and conjunctival surfaces locally. This approach directly tackles both the mechanical obstruction and the infection, and it’s more effective than observation or using only topical drops. Immediate surgical removal isn’t first-line unless the infection is chronic or unresponsive to conservative management.