A Case of SmartPlug Partial Extrusion through Canalicular Mucosa

PURPOSE: To report a case of a SmartPlug that partially extruded through the canalicular mucosa. CASE SUMMARY: A 62-year-old female patient visited our Department of Ophthalmology for redness and discharge in her right eye that began worsening a week prior. The patient was diagnosed with severe dry eye syndrome via Sjogren's syndrome. The SmartPlug was inserted into her left lower punctum 12 years prior, and another plug was inserted in the right 9 years prior. Nothing notable was found in her history. The best corrected visual acuity and intraocular pressure at the initial visit was 1.0 and 14 mmHg, respectively, in both eyes. Swelling, erythema, and tenderness at the right lower punctum were identified. As we irrigated the lower lacrimal system, partial obstruction was suspected and a large amount of mucopurulent discharge in the conjunctival fornix with conjunctival injection was seen. Under the right lower punctum, a 1 × 1 mm yellowish foreign body was partially extruding from the canalicular mucosa. The foreign body was removed, and a round defect was left. The patient's symptom completely resolved after 4 weeks of topical antibiotics and ointment treatment. CONCLUSIONS: In patients who have a SmartPlug inserted prior to visits for redness and discharge, a SmartPlug plug extrusion should be considered.

Treatment of the SmartPLUG-related Canaliculitis

PURPOSE: To report on the treatment approach of canaliculitis related to SmartPLUG use and its clinical manifestation. METHODS: A retrospective chart review of eight patients who had canaliculitis after the insertion of the SmartPLUG was conducted. RESULTS: Seven out of eight cases with canaliculitis related to the SmartPLUG required extraction of the SmartPLUG. While four cases were removed with only retrograde massage, two cases required surgical treatment. CONCLUSIONS: Canaliculitis related to SmartPLUG use is rarely reported. However, canaliculitis as a complication is difficult to treat and often leads to surgery. In canaliculitis related to SmartPLUG use, retrograde massage as a non-surgical method for the simple and effective removal of the SmartPLUG can be beneficial.

Canaliculitis Associated With SmartPlugtrade mark Punctal Plug Insertion: Clinical Features and Management

PURPOSE: To report the clinical features and treatment of canaliculitis associated with SmartPlug punctal plug insertion. METHODS: Case selection criteria included patients with canaliculitis, who were managed at Seoul National University Hospital from January 2006 to October 2008, presenting with a history of punctal plug insertion. The operation reports were reviewed to identify patients in whom SmartPlug was discovered during the operation. Six patients (8 eyes) were identified, and a retrospective chart review was performed for all the patients. RESULTS: The mean age of the patients was 34.3+/-8.6 years, and there were 1 men and 5 women. Common symptoms were mucous discharge (6 eyes) and conjunctival injection (2 eyes). The mean time from insertion of the plug to onset of symptoms was 27.0+/-27.0 months (range 4 to 77 months). All patients underwent surgical removal of the punctal plug by one-snip punctoplasty, canalicular retrograde compression using 2 cotton-tipped applications (2 eyes), or canalicular curettage (6 eyes). All patients had resolution of symptoms after the procedure. CONCLUSIONS: Canaliculitis should be considered when there is conjunctival discharge or injection in patients with SmartPlug. One-snip punctoplasty and retrograde compression of canaliculus can be attempted preferentially as a minimally-invasive treatment option.