Plug surface defects as a late complication of silicone punctal plugs

Purpose: To report 3 cases of punctal plug surface defects as a cause of irritation complicating punctal plug therapy. Methods: Interventional case series and scanning electron microscopy (SEM) of punctal plugs. Results: Three patients were found to have punctal plug surface defects and local irritation of conjunctiva and inferonasal cornea 9, 40, and 69 months after placement of AquaFlo silicone punctal plugs for the treatment of dry eyes. SEM of the explanted plugs confirmed a defective collarette surface. In addition, unused AquaFlo plugs from different lots examined by SEM showed a rough irregular collarette surface that was not seen in unused plugs of Parasol silicone punctal plugs. DISCUSSION:: AquaFlo punctal plugs inherently have surface irregularities when compared with similar plug brands, which we suggest may predispose to plug breakdown over time, leading to mechanical irritation of the adjacent conjunctiva and cornea. This report highlights the local complications by AquaFlo punctal plugs associated with plug surface defects as a complication of punctal plug therapy.