Treatment of the SmartPLUG-related Canaliculitis

Sung Min Ahn; Ho Chang Kim; Jea Woo Jang; Sung Joo Kim

doi:10.3341/jkos.2009.50.12.1768

Journal List > J Korean Ophthalmol Soc > v.50(12) > 1008436

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Ahn, Kim, Jang, and Kim: Treatment of the SmartPLUG-related Canaliculitis

Original Article

J Korean Ophthalmol Soc 2009;50(12):1768-1773.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.12.1768

Treatment of the SmartPLUG-related Canaliculitis

Sung Min Ahn, MD¹, Ho Chang Kim, MD, PhD¹, Jea Woo Jang, MD, PhD², Sung Joo Kim, MD²

¹Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Korea

²Myung Gok Eye Reserch Institute, Kim's Eye Hospital, Konyang University, Seoul, Korea

Address reprint requests to Ho Chang Kim, MD, PhD, Department of Ophthalmology, Dongguk University College of Medicine, #1090-1 Sukjang-dong, Gyeongju, 780-350, Korea Tel: 82-54-770-8256, Fax: 82-54-772-9618, E-mail: ophho@hanmail.net

Received 19 May 2009 Accepted 30 September 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

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Keywords: Canaliculitis, Retrograde massage, SmartPLUG

References

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Figure 1.

Photographs of the patients 3 (A) and 5 (B) with canaliculitis showing peripunctal swelling and injection.

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Figure 2.

The scheme of the retrograde massage. It starts pressing the lacrimal sac and progress apart to the punctum.

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Figure 3.

The removed SmartPLUG by retrograde massage in the patient 5

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Figure 4.

The biopsy of the pericanalicular tissue reveals dense infiltration of mixed inflammatory cells, including plasma cells, small lymphocytes and neutrophils in the subepithelial connective tissue (hematoxylin-eosin stain, ×400)

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Table 1.

Summary of clinical symptoms and prognosis of patients with canaliculitis after SmartPLUG insertion

Patient No.	Sex	Age (yrs)	Duration of maintaining plug	Symptom and sign	Treatment	Outcome
1	M	51	4 weeks	Peripunctal injection with tenderness	Topical moxifloxacin 0.5%	Resolution after treatment 1 week
2	F	33	3 months	Papillary swelling with erythema	Topical moxifloxacin 0.5% and retrograde massage	Resolution after removal of punctual plug by retrograde massage for 3 weeks.
3	M	57	6 weeks	Peripunctal injection with tearing, tenderness and purulent discharge	Canaliculotomy with silicone intubation	Resolution after removal of SmartPlug
4	F	61	4 weeks	Peripunctal conjunctival swelling with tenderness	Topical moxifloxacin 0.5% and retrograde massage	Resolution after removal of SmartPlug by retrograde massage for 4 weeks.
5	F	41	1 year	Papillary edema with tenderness and tearing	Topical moxifloxacin 0.5% and retrograde massage	Resolution after removal of SmartPlug by retrograde massage showing an example to patient
6	F	33	4 months	Conjunctival injection with purulent discharge	Lacrimal irrigation, then SmartPlug escaped to lacrimal sac.	Patient blew her nose out frequently, then 2days later SmartPlug came out through the nose
7	M	59	4 months	Erythema of the Lower lid and irritation, tearing	Probing, then SmartPlug escaped to lacrimal sac.	Fail to removal of SmartPlug by conservative method, then DCR with silicone intubation performed
8	F	46	6 weeks	Papillary edema with irritation and tearing	Topical moxifloxacin 0.5% and retrograde massage	Resolution after removal of SmartPlug by retrograde massage showing an example to patient

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