title: Silicone punctal plug extrusion resulting from spontaneous dissection of canalicular mucosa: A clinical and histopathologic report.
abstract: OBJECTIVE
  To report on an uncommon, previously unidentified, progressive silicone punctal plug extrusion.
  
  
  METHODS
  Small, retrospective case series.
  
  
  METHODS
  Five cases of punctal plug extrusion were identified among a series of 424 consecutive implantations. Histopathologic analysis was obtained in one case. One additional referred case was included in this report.
  
  
  RESULTS
  The plugs were completely extruded from the punctal lumen 6 to 14 months after insertion after an otherwise uncomplicated postoperative course. All plugs were retained at the punctal margin by an encircling band of vascularized mucosal tissue originating from the canalicular lumen. The band consisted of connective tissue of canalicular mucosal origin, attached just below the junction of the punctal and canalicular epithelium. Mild mononuclear infiltration was present in the connective tissue component of the punctal region. There was no cytologic or architectural evidence of abnormal epithelium or connective tissue or of pyogenic granuloma.
  
  
  CONCLUSIONS
  These observations suggest that progressive lacrimal punctal plug extrusion may relate to mucosal dissection by the plug edges. We speculate that mechanical stress induced by eyelid closure on an improperly sized or placed implant may result in plug tilt. Subsequent epithelial hyperplasia further enhances the tilt, and the sharper edge of the conical bulb promotes separation of the canalicular mucosa from its distal luminal aspect. At the completion of the extrusion, the mucosal surface is separated from its connective tissue base, at a proximal subpunctal level, causing formation of an encircling tissue band.
authors.affiliation: Department of Ophthalmology, Hôtel-Dieu de Paris, University of Paris VI, School of Medicine, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Fayet
authors.forename: M
authors.initials: M
authors.lastname: Assouline
authors.forename: S
authors.initials: S
authors.lastname: Hanush
authors.forename: J
authors.initials: J
authors.lastname: Bernard
authors.forename: F
authors.initials: F
authors.lastname: D'Hermies
authors.forename: G
authors.initials: G
authors.lastname: Renard
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials; D003238:Connective Tissue / Q000473:pathology; D015352:Dry Eye Syndromes / Q000601:surgery; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology* / Q000473:pathology*; D006801:Humans; D006965:Hyperplasia; D007765:Lacrimal Apparatus / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D019736:Prostheses and Implants; D012189:Retrospective Studies; D012826:Silicone Elastomers
chemical_list: D001672:Biocompatible Materials; D012826:Silicone Elastomers