title: Pyogenic granulomas after silicone punctal plugs: a clinical and histopathologic study.
abstract: OBJECTIVE
  To describe clinical findings, histopathologic changes, and risk factors for pyogenic granuloma formation complicating silicone punctal plug therapy.
  
  
  METHODS
  Retrospective observational case series.
  
  
  METHODS
  Between November 2000 and April 2004, 903 silicone punctal plugs of the same brand were inserted in 404 subjects. Cases associated with pyogenic granuloma formation were identified and reviewed. Granulation tissue was obtained from 10 patients for histopathologic examination. Multiple risk regression analyses identified factors related to pyogenic granuloma development and factors associated with histologic patterns.
  
  
  RESULTS
  Pyogenic granuloma development led to the extrusion of 4.2% of all plugs placed in a median time period of 141 days. All patients presented with varying degrees of plug extrusion. Similar distributions of partial and complete plug extrusions, as well as bilateral and unilateral plug extrusions, were seen. Findings at presentation ranged from a subclinical pyogenic granuloma causing partial plug extrusion to a pyogenic granuloma in the punctum with a ring of fibrovascular tissue retaining a completely extruded plug. Histopathologic examination revealed two patterns, representing either acute pyogenic granuloma or involuting pyogenic granuloma. Pyogenic granulomas resolved after 3.1 +/- 1.3 weeks in all patients after plug removal. Multiple regression analysis revealed that large plug size was associated with increased pyogenic granuloma formation (P < .0001). Partial or complete plug extrusion was associated with active or involuting pyogenic granuloma, respectively (P = .023).
  
  
  CONCLUSIONS
  Pyogenic granuloma-related spontaneous plug extrusions may be more common than previously thought and can present with a range of clinical findings. The degree of plug extrusion correlates with the histopathologic pattern. Larger plug size and sharp edges in plug geometry may be responsible for pyogenic granuloma formation.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Kim
authors.forename: Smajo S
authors.initials: SS
authors.lastname: Osmanovic
authors.forename: Deepak P
authors.initials: DP
authors.lastname: Edward
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015352:Dry Eye Syndromes / Q000601:surgery; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology / Q000473:pathology / Q000601:surgery; D017789:Granuloma, Pyogenic / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007765:Lacrimal Apparatus / Q000601:surgery*; D007766:Lacrimal Apparatus Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012826:Silicone Elastomers / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D012826:Silicone Elastomers