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Canaliculitis associated with multiple retained silicone punctal plugs and concurrent biodegradable plug placement
Jason Zheng1, Jainam Shah1,2, Sachin Pathuri1
1Jules Stein Eye Institute and Department of Ophthalmology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
BMJ Case Reports
|July 7, 2026
Summary
Retained punctal plugs, particularly silicone ones, can cause canaliculitis. This case shows a patient developed infection after new biodegradable plugs were inserted, highlighting the need to check for old plugs first.
Area of Science:
- Ophthalmology
- Oculoplastics
Background:
- Punctal occlusion is a standard treatment for dry eye syndrome.
- It involves inserting plugs to slow tear drainage.
- Both permanent and biodegradable plugs are used.
Purpose of the Study:
- To report a case of canaliculitis following biodegradable punctal plug insertion.
- To emphasize the importance of checking for retained plugs before new insertions.
Main Methods:
- A case report of a female patient in her 60s.
- Describing the development of canaliculitis after receiving biodegradable plugs.
- Surgical exploration and removal of retained plugs.
Main Results:
- The patient developed left inferior canaliculitis four days after biodegradable plug insertion.
- Surgical exploration revealed one biodegradable plug and five retained silicone plugs.
- Infection resolved with surgical intervention and antibiotics.
Conclusions:
- Retained silicone plugs are a significant risk factor for canaliculitis.
- New plug insertion may precipitate infection in the presence of retained foreign material.
- Confirming canalicular patency before new plug insertion is crucial to prevent complications.
