Canaliculitis Associated With SmartPlugTM Punctal Plug Insertion: Clinical Features and Management

Min Joung Lee; Kyeong Wook Lee; Nam Ju Kim; Ho-Kyung Choung; Sang In Khwarg

doi:10.3341/jkos.2009.50.6.821

Journal List > J Korean Ophthalmol Soc > v.50(6) > 1008570

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Lee, Lee, Kim, Choung, and Khwarg: Canaliculitis Associated With SmartPlugTM Punctal Plug Insertion: Clinical Features and Management

Original Article

J Korean Ophthalmol Soc 2009;50(6):821-825.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.6.821

Canaliculitis Associated With SmartPlug^TM Punctal Plug Insertion: Clinical Features and Management

Min Joung Lee, MD^1,², Kyeong Wook Lee, MD^1,², Nam Ju Kim, MD^1,³, Ho-Kyung Choung, MD^1,⁴, Sang In Khwarg, MD^1,²

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

²Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea

³Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul, Korea

⁴Department of Ophthalmology, Seoul National University Boramae Hospital, Seoul, Korea

Address reprint requests to Sang In Khwarg, MD Department of Ophthalmology, Seoul National University Hospital #28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-2087, Fax: 82-2-741-3187, E-mail: khwarg@snu.ac.kr

Received 1 December 2008 Accepted 20 February 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 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.

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Keywords: Canaliculitis, Complication, Punctal plug, SmartPlug

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Figure 1.

(A) Preoperative appearance of a punctum in a patient with canaliculitis (Case No. 5–1). Note punctal and canalicular swelling, discharge in a lumen, and conjunctival injection. (B) SmartPlug removed during one snip punctoplasty and canalicular curettage. (C) Photograph of the same case 14 months after the procedure. There is no sign of canaliculitis.

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Table 1.

Clinical presentation and treatment of patients with canaliculitis after SmartPlug insertion

Case No.	Age (years)	Sex	Affected area	Time from plug insertion to onset of symptom	Duration of symptom	Presenting symptoms	Treatment
1	30	F^*	LLL^‡	12	4	Mucous discharge, lower lid swelling	One-snip punctoplasty, canalicular curettage
2	36	F	LLL	18	4	Mucous discharge	One-snip punctoplasty, canalicular curettage
3	50	M^†	RLL^§	4	1	Mucous discharge	One-snip punctoplasty, canalicular curettage
4	35	F	LLL	24	3	Pus from punctum	One-snip punctoplasty, canalicular curettage
5–1	25	F	LLL	4	1	Mucous discharge, tearing	One-snip punctoplasty, canalicular curettage
6–1	30	F	LLL	60	5	Conjunctival injection, discharge	One-snip punctoplasty, canalicular curettage
5–2	25	F	RLL	19	2	Bloody discharge	One-snip punctoplasty, canalicular curettage & squeezing
6–2	30	F	RLL	77	3	Conjunctival injection, discharge	One-snip punctoplasty, canalicular squeezing

^* F=female

^† M=male

^‡ LLL=left lower lid punctum

^§ RLL=right lower lid punctum.

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