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April 1989

Problems With Punctal Plugs

Author Affiliations

Toronto, Canada
Santa Monica, Calif

Arch Ophthalmol. 1989;107(4):493-494. doi:10.1001/archopht.1989.01070010507014

To the Editor.  —Punctal occlusion has proved to be a valuable adjunct in the treatment of moderate to severe dry-eye syndrome. Recently, silicon plugs have become available for reversible occlusion of the lacrimal punctum and canaliculus.1 Although this device has proved beneficial to many cases in our experience, its use is not without some potential hazard, as the following two case reports will indicate.

Report of Cases.  —Case 1.—A 29-year-old woman suffered from moderate dry-eye syndrome that caused irritation, particularly of the right eye. Since she was helped by temporary occlusion of her canaliculi with collagen inserts, we elected to perform punctal occlusion using a punctal plug for her lower right punctum. The lower lid was grasped with forceps in the recommended manner and the punctum was dilated with the punctal dilator supplied by the manufacturer. An attempt was then made to insert the plug, but, because of the

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