Comparative efficacy of treatment modalities for idiopathic canalicular inflammatory disease: A prospective study

Abstract

Background Idiopathic Canalicular Inflammatory Disease (ICID) lacks evidence-based management. We compared the long-term efficacy of four treatment modalities using anterior segment optical coherence tomography (AS-OCT) as an objective biomarker. Materials and methods Prospective randomized study included 52 patients ( 87 eyes ) with ICID allocated to topical corticosteroids, cyclosporine A (Cs A), monocanalicular intubation, and combined therapy (intubation + Cs A). Evaluations included the Munk scale, punctal size, and AS-OCT morphometry at baseline, post-treatment, and at 6–12 months of follow-up. Results Cs A monotherapy demonstrated the most stable functional outcome; the median Munk score decreased significantly and remained sustained at 6–12 months (72.7% success; median recurrence 473 days). Intubation yielded superior short-term anatomical results, but showed functional regression after extubation. Combined therapy demonstrated poor efficacy (0% success at 6–12 months; median recurrence 93 days), likely due to the stent-induced limitation of Cs A exposure. AS-OCT identified canalicular lumen diameter and punctal epithelial thickness as independent predictors of success. Conventional clinical scales have shown insufficient sensitivity compared to AS-OCT. Conclusion. Prolonged Cs A monotherapy provides superior long-term outcomes compared with mechanical interventions, supporting an anti-inflammatory approach. AS-OCT morphometry is a sensitive tool for predicting the treatment success. Combined therapy with simultaneous stent placement and Cs A should be reconsidered because of counterproductive mechanical barrier effects.