title: Acute conjunctivitis associated with biofilm formation on a punctal plug.
abstract: BACKGROUND
  Punctal plugs are used for the treatment of tear-deficient type dry eye. We recently examined a case of acute conjunctivitis associated with bacterial biofilm formation on a punctal plug.
  
  
  METHODS
  A 63-year-old woman diagnosed as having tear-deficient type dry eye came to our hospital with a complaint of soreness in her right eye. Punctal plugs had been inserted into this eye 5 1/2 months previously. On the day of her visit, she presented with acute conjunctivitis.
  
  
  METHODS
  In biomicroscopical examination, the top of the punctal plug was seen to be covered with a whitish soft material. Microbiological analysis performed on a part of this material was positive for Staphylococcus haemolyticus and Candida tropicalis. Scanning electron microscopy of the removed punctal plug revealed widespread bacterial colonization embedded within an extensive extracellular matrix. Treatment consisted of the replacement of the plug, and administration of a combination of antibacterial eyedrops and preservative-free artificial solution. As a result, the acute conjunctivitis cleared up within 1 month.
  
  
  CONCLUSIONS
  This case suggests that a punctal plug poses a potential risk of causing the formation of bacterial biofilm. In such a case, replacement of the plug and/or removal of the accumulated materials should be considered.
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Yokoi
authors.forename: K
authors.initials: K
authors.lastname: Okada
authors.forename: J
authors.initials: J
authors.lastname: Sugita
authors.forename: S
authors.initials: S
authors.lastname: Kinoshita
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents; D018441:Biofilms / Q000254:growth & development*; D002175:Candida / Q000502:physiology* / Q000648:ultrastructure; D002177:Candidiasis / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D003228:Conjunctiva / Q000382:microbiology / Q000601:surgery / Q000648:ultrastructure; D003234:Conjunctivitis, Bacterial / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D015352:Dry Eye Syndromes / Q000628:therapy; D005109:Extracellular Matrix / Q000382:microbiology / Q000648:ultrastructure; D005260:Female; D006801:Humans; D008875:Middle Aged; D009883:Ophthalmic Solutions; D016459:Prosthesis-Related Infections / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D013210:Staphylococcus / Q000502:physiology* / Q000648:ultrastructure
chemical_list: D000900:Anti-Bacterial Agents; D009883:Ophthalmic Solutions