March 2012
Volume 53, Issue 14
ARVO Annual Meeting Abstract  |   March 2012
Plug Erosion as a Late Complication of Silicone Punctal Plugs
Author Affiliations & Notes
  • Stella C. Paparizos
    Ophthalmology, Summa Health System, Akron, Ohio
  • Smajo Osmanovic
    Ophthalmology, Arlington Eye Physicians, Arlington Heights, Illinois
  • Deepak Edward
    Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
    Ophthalmology, Wilmer Eye Institute John Hopkins University, Baltimore, Maryland
  • Footnotes
    Commercial Relationships  Stella C. Paparizos, None; Smajo Osmanovic, None; Deepak Edward, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 2364. doi:
  • Views
  • Share
  • Tools
    • Alerts
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      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.

      Download citation file:

      © ARVO (1962-2015); The Authors (2016-present)

  • Supplements

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.  


Keywords: cornea: tears/tear film/dry eye 

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.