Fistula disease of the eye refers to the constant overflow of pus or thin, turbid tears from the lacrimal punctum. Since the lacrimal punctum opens at the canthus, it is also known as "canthus pyorrhea (chronic dacryocystitis)."

This conditionis referred to as "canthus pyorrhea (chronic dacryocystitis) syndrome" in the "Zhubing Yuanhou Lun"; Yuanji Qiweicalls it "a disease where heat accumulation must ulcerate"; both "Michuan Yanke Longmu Lun" and Shiyi Dexiao Fangrefer to it as "fistula disease with eye pus discharge"; Zhengzhi Zhunshengrefers to it as "inner canthus fistula disease," "canthus pyorrhea (chronic dacryocystitis)," and also mentions other disease names such as "external fistula disease"; Yinhai Jingweidescribes "fistula disease with eye pus and blood" as "wind-heat congestion and toxin attacking the black of the eye iris, causing toxic sores, irrigating the water and controlling the blood, leading to ulceration and pus discharge," which actually belongs to wind orbiculus and water orbiculus diseases, not within the scope of this disease. The "Gujin Yitong" describes "fistula disease with eye pus and blood" as "sores inside the eye with pus and blood flowing," which is also not this condition and should be distinguished.

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1. Wind-heat External Contraction︰The inner canthus exhibits grade I distending pain, with slightly reddened skin and a localized grade I swelling. Pressure causes the discharge of pus or thin, turbid tears. Accompanied by symptoms such as aversion to cold with fever, headache, body pain, a red tongue with white coating, and a floating-rapid pulse. This condition is often caused by wind-heat toxins invading the eye orifices, lingering in the eyelids, and stirring internal fire, resulting from the combination of internal and external pathogens. The *Shen Shi Yao Han·Fistula Disease of the Eye* states: "The cause is wind-heat stagnating in the eye, condensing into pus-like tears that overflow." *Zhubing Yuanhou Lun* explains: "Wind-heat lodges between the eyelid and canthus, where heat contends with blood, causing accumulation within the canthus. As body fluids persist unceasingly, the discharge does not cease, hence it is called pus fistula disease." Wind-heat external contraction manifests as aversion to cold with fever, a red tongue, floating-rapid pulse, and other signs of exterior heat syndrome. Wind-heat stagnation in the eyelid and canthus leads to redness, swelling, and distending pain in the canthus and eyelids. Treatment should focus on releasing the exterior with pungent-cool herbs, and the formula *Dispersing Wind and Clearing Liver Powder* is recommended.
2. Exuberance of Heart Fire︰The inner canthus is significantly swollen and painful, with hard nodules that are tender to touch, accompanied by fever, thirst, dark urine, a red tongue, and a rapid pulse. This condition is often caused by prolonged accumulation of pathogenic heat in the Heart Meridian, which attacks the inner canthus. Key diagnostic features include obvious redness, swelling, heat, and pain in the inner canthus, fever, thirst, a red tongue, and a rapid pulse. The treatment principle is to clear heat and remove toxins, with the recommended prescription being Bamboo Leaf Xiexin Decoction.
3. Retention of Pathogenic Heat︰Swelling and pain in the inner canthus, softening upon pressure, with pus discharge from the lacrimal punctum, fever, thirst, red tongue, and rapid pulse. This is often caused by prolonged stagnation of heat toxin, which corrodes the skin and gradually forms pus. The pus accumulates in the lacrimal punctum, leading to discharge upon pressure. The retention of pathogenic heat results in fever, thirst, red tongue, and rapid pulse. Treatment should focus on clearing the heart and expelling pus, using the Clearing Heart Pus-Draining Decoction.
4. Deficiency of Both Qi and Blood︰Swelling of the canthus persists for a long time, with gradual reduction in redness and pain. Only thin pus or greenish-black foul-smelling purulent discharge continuously overflows from the lacrimal punctum, failing to heal over time. The patient exhibits physical weakness, lack of strength, dull complexion, pale tongue, and thin, weak pulse. This indicates a constitution inherently deficient, where healthy qi cannot overcome pathogenic factors, resulting in persistent purulent discharge from the lacrimal punctum despite the absence of redness and swelling in the canthus. Treatment should focus on reinforcing healthy qi and eliminating pathogenic factors, using the formula Ginseng Nutrient-Nourishing Decoction.

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1. Yuanji Qiwei．The disease of heat accumulation leading to ulceration: "The inner canthus point resuscitation is like acupuncture to the eye, pressing it causes pus to ooze out. Some have both eyes affected, while others have only one eye affected. The eyes belong to the liver, and the inner canthus belongs to the bladder. This is caused by the accumulation of pathogenic factors in a single meridian, hence it is called the disease of heat accumulation leading to ulceration. It is also known as fistula disease of the eye."
2. Puji Fang．Eye Diseases: "Chronic dacryocystitis is due to the congestion of blood and heat, which spreads to the taiyang bladder meridian. The bladder meridian originates from the inner canthus, causing swelling of the eyelid and canthus. Prolonged itching leads to the disease, with pus continuously oozing, resembling a fistula disease of an organ. Therefore, it is called pus fistula disease, commonly known as fistula disease of the eye."