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Stella C. Paparizos, Smajo Osmanovic, Deepak Edward; Plug Erosion as a Late Complication of Silicone Punctal Plugs. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2364.
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© ARVO (1962-2015); The Authors (2016-present)
To report three cases of late punctal plug erosion following punctal plug insertion.
Interventional case series and scanning electron microscopy of punctal plugs.
Three patients had silicone punctal plugs placed (AquaFlo Quintess, AlphaMed, El Paso, TX, USA) for the treatment of moderate-to-severe dry eyes. At 9, 40, and 69 months after placement, the patients developed symptoms of irritation, foreign body sensation, and conjunctival injection. Examination revealed punctal plug erosion with fluorescein staining of the nasal conjunctiva and infero-nasal cornea. Symptoms resolved after plug removal and treatment with steroid/antibiotic solution for 4-7 days. Scanning electron microscopy (SEM) of the explanted plugs demonstrated a rough collarette surface suggestive of damage (Figure 1). Furthermore, SEM of several unused AquaFlo plugs from different lots showed an irregular collarette surface that was not seen in unused plugs of another brand (Parasol, Odyssey Medical Inc., Memphis, Tennessee, USA) (Figure 2).
Punctal plug erosion is a cause of late local complication of AquaFlo punctal plugs. Surface irregularities of the collarette may predispose to erosion of the exposed plug over time, leading to mechanical irritation of the adjacent conjunctiva and cornea. To the author’s knowledge, this is the first report of local complications by AquaFlo punctal plugs and the first report of plug erosion as a local complication of punctal plug therapy.
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