To the Editor.
—Since its introduction more than 10 years ago,1 the Freeman punctal plug (Eagle Vision, Memphis, Tenn) has been found to be useful in a subset of patients suffering from moderately severe keratoconjunctivitis sicca.2 The original design of the plugs had a large outer cap that often caused a foreign-body sensation and precluded long-term tolerance. Recently, two new plug designs (medium and small sizes) have been made available.We first used the smallest size plug (model 003) in May 1988. Since then, we have observed two types of complications with this new design that had not been noted with the original larger design: punctal scarring after removal of the plugs in one patient, and loss of the plugs into the canaliculi in three patients.
Report of Cases.
—Freeman punctal plugs were placed in all four puncta of a 49-year-old woman with keratoconjunctivitis sicca.
Maguire LJ, Bartley GB. Complications Associated With the New Smaller Size Freeman Punctal Plug. Arch Ophthalmol. 1989;107(7):961-962. doi:10.1001/archopht.1989.01070020023015