Update on Idiopathic Canalicular Inflammatory Disease (ICID): Outcomes With Addition of Topical Cyclosporine and the Modified Treatment Protocol.

PURPOSE: The objective of this study is to present clinical outcomes with addition of topical cyclosporine while managing cases of "idiopathic canalicular inflammatory disease" and to propose a modified treatment protocol.

METHODS

Prospective case series of 88 canaliculi of 44 eyes of 22 patients diagnosed as "idiopathic canalicular inflammatory disease" at a tertiary care Dacryology service over a period of 2 years. All the patients were diagnosed based on the published major and minor criteria and each of the canaliculus was clinically staged. All patients were treated initially with a combination of topical cyclosporine (0.05%) and rapidly tapering topical steroids followed by punctal dilatation and placement of mini-monoka stents after control of inflammation. Monoka stents were extubated at 6 weeks and the cyclosporine was continued for at least up to 3 months beyond the extubation of stents. Patient demographics, investigations, response to cyclosporine, management modalities, recurrence of inflammation, anatomical and functional outcomes were analyzed.

RESULTS

Eighty-eight canaliculi were diagnosed to have idiopathic canalicular inflammatory disease during the study period. There was a female preponderance (77%, 17/22) and the mean age at presentation was 51 years. All patients presented with bilateral epiphora (mean duration 4.5 months) without any discharge. Staging revealed 18, 27, 24, and 19 canaliculi were involved with stages 1-4, respectively. The mean duration of cyclosporine use was 5.7 months. All patients except 3 (19/22) underwent monoka dilatation. Complete anatomical and functional resolution were noted in 62% (55/88), of which 12 puncta and canaliculi, all stage 1 (13.6%, 12/88) showed complete resolution with cyclosporine alone. Relentless disease progression to stage 5 was noted in 30% (26/88) of the puncta and canaliculi. All the younger patients (<30 years, 13.6%, 3/22) demonstrated poor outcomes.

CONCLUSIONS

The addition of topical cyclosporine is beneficial in controlling inflammation and disease downstaging in patients with idiopathic canalicular inflammatory disease. The current modified treatment protocol salvages majority of the canaliculi.