The lacrimal caruncle is a small, soft tissue structure located at the inner corner of the eye. Experiencing pain or irritation in this highly sensitive area is common, ranging from minor environmental annoyance to a more serious medical condition. This article explores the causes of caruncle discomfort, helping to distinguish between temporary irritation and symptoms that warrant professional attention.
What is the Lacrimal Caruncle
The lacrimal caruncle is a small, pinkish, globular nodule situated at the medial canthus, the inner corner of the eye closest to the nose. It is composed of modified skin containing hair follicles, sebaceous glands, and sweat glands. Its close neighbor is the plica semilunaris, a fold of conjunctiva often referred to as the third eyelid remnant. The caruncle’s glandular composition means it secretes a whitish, oily substance that contributes to the tear film and often collects as “sleep” in the corner of the eye. Because it is an exposed structure containing multiple types of glands, the caruncle is naturally susceptible to irritation, inflammation, and infection.
Common Sources of External Irritation
The most frequent causes of caruncle discomfort stem from external and behavioral factors that do not involve infection. One common issue is Dry Eye Syndrome, where a lack of proper lubrication causes the exposed surfaces, including the caruncle, to become dry and irritated. This can lead to a gritty or burning sensation that mimics a foreign body. Allergies also frequently affect this area, causing the caruncle and the surrounding conjunctiva to become inflamed and itchy due to histamine release.
Mechanical irritation from foreign bodies often causes acute, short-term pain in the caruncle region. Tiny particles like dust, grit, or makeup residue can become lodged in the inner corner, causing friction when the eye moves or blinks. Habitual eye rubbing, whether due to fatigue or irritation, introduces mechanical stress that can lead to localized swelling and tenderness of the delicate caruncle tissue. This trauma can exacerbate existing dryness or minor inflammation, creating a cycle of discomfort.
Specific Inflammatory Conditions
Pain in the caruncle area can signal specific medical conditions involving an infectious or inflammatory process. Carunculitis is inflammation or infection focused specifically on the sebaceous and sweat glands within the caruncle itself. This localized infection typically results in a tender, red, and swollen lump that may be mistaken for a stye or pimple. Acute Conjunctivitis, commonly known as pink eye, often causes significant inflammation of the entire inner eyelid and surrounding tissue, including the caruncle. The resulting redness, swelling, and discharge contribute directly to localized pain.
Infections of the tear drainage system can also present with pain radiating to the inner corner of the eye. Dacryocystitis is an infection of the lacrimal sac, which sits just beneath the skin near the nose, adjacent to the caruncle. This condition typically causes acute onset of severe pain, redness, and a tender, swollen mass, often accompanied by pus and excessive tearing. Canaliculitis is a less common infection affecting the small tear-draining channels (canaliculi), causing localized swelling, tenderness over the duct, and discharge from the tear duct opening. Growths such as papillomas or retention cysts can also develop on the caruncle, causing chronic friction or pressure that results in persistent discomfort.
Identifying Symptoms Requiring Professional Care
While minor irritation often resolves with home care like warm compresses or artificial tears, certain symptoms indicate a need for professional medical evaluation. Any change in vision, such as sudden blurriness or double vision, should prompt immediate consultation with an eye care specialist. Persistent, severe pain that rapidly worsens, or pain accompanied by a fever, suggests a spreading or serious infection like acute dacryocystitis.
The presence of thick, yellow, or green discharge, particularly if pus-like material can be expressed from the inner corner, is a strong indicator of a bacterial infection requiring prescription treatment. Pain accompanied by photophobia (extreme sensitivity to light) can signal a deeper inflammatory process that needs urgent attention. If any caruncle-related symptom lasts longer than 48 hours without showing clear signs of improvement, seeking an examination ensures a correct diagnosis and prevents potential complications.