Spontaneous Canalicular Plug Erosion After Punctal Plug Placement

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To the Editor:
It was with great interest that we read the article titled “Spontaneous canalicular plug erosion after punctal plug placement” by Zhang et al.1 We have a few observations to make.
The authors have mentioned findings of partial extrusion of a punctal plug in 2013, which subsequently eroded through the canaliculus in 2015. Treatment for partial extrusion of plugs is either reinsertion or removal of the plug. If left untreated, partially extruded plugs cause chronic irritation, inflammation, and they subsequently erode overlying tissues. The authors have not mentioned any remedial action being taken at the first sign of partial extrusion. Timely intervention in cases of partial extrusion can reduce the complication rates associated with punctal or intracanalicular plugs.
We wish to know whether there were any signs of associated canaliculitis or punctal infections. Canaliculitis and infections around the punctum are known complications of punctal plug placement.2 Removal of punctal plugs is recommended, in cases with infections or partial erosion, to prevent further complications such as complete erosion.2,3
Punctal plug erosion may occur spontaneously without signs of secondary infections as described by Fayet et al.4 Hence, regular follow-up and careful slit-lamp examination are necessary to detect early signs of punctal plug extrusion or erosion.
We concur with the authors that punctal plugs improve symptoms in patients with severe dry eyes due to keratoconjunctivitis sicca. Meticulous examination of the punctum and canaliculus at each visits and timely intervention can help in reducing complications associated with these plugs.
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