title: Management of complications after insertion of the SmartPlug punctal plug: a study of 28 patients.
abstract: OBJECTIVE
  To characterize and describe the management of complications seen in patients who have undergone insertion of the SmartPlug permanent punctal plug.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Patients who experienced complications after SmartPlug insertion and were treated by 1 of 18 ophthalmic plastic and reconstructive surgeons between January 2004 and October 2005.
  
  
  METHODS
  Presenting symptoms and signs and the management of complications were analyzed.
  
  
  METHODS
  Prevalences of canaliculitis and dacryocystitis, tearing at presentation, and outcome of conservative and/or surgical management of the SmartPlug complications.
  
  
  RESULTS
  Twenty-eight patients were included in the study; 13 had bilateral involvement. On initial presentation, 18 patients had inflammation, including 17 with canaliculitis and 1 with recurrent acute dacryocystitis. Ten patients had little or no inflammation; all 10 had tearing of the involved eye(s). In 5 patients, complications resolved after office irrigation of the lacrimal drainage system; in a sixth patient, silicone intubation was performed as well. Canaliculotomy was performed in 13 patients (bilateral in 3) and combined with silicone intubation (3 patients). Canaliculotomy was planned in an additional 2 patients. Canaliculitis in 1 patient responded to a course of oral antibiotics; the plug was massaged out of the punctum in a retrograde fashion in another patient. In still another patient, the plugs expressed themselves at the time of planned canaliculotomy. In 4 patients, dacryocystorhinostomy (DCR) with silicone intubation was necessary. Two additional patients refused further treatment including DCR and canaliculotomy; both were lost to follow-up.
  
  
  CONCLUSIONS
  Canaliculitis, acute dacryocystitis, and tearing may be seen in patients who have had SmartPlugs and may be managed by removal of the plug. A trial of topical and oral broad-spectrum antibiotics followed by retrograde massage of the plug through the canaliculus may be helpful should plug removal be deemed appropriate. If conservative measures fail, canaliculotomy with removal of the plug may be considered; DCR may be necessary. Although lacrimal irrigation may resolve the problem, irrigation also may dislodge the plug from its canalicular position and cause permanent obstruction of the lacrimal drainage system.
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003607:Dacryocystitis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D020878:Device Removal; D015352:Dry Eye Syndromes / Q000601:surgery; D005260:Female; D006801:Humans; D007765:Lacrimal Apparatus / Q000601:surgery; D008297:Male; D008405:Massage; D008875:Middle Aged; D011183:Postoperative Complications; D019736:Prostheses and Implants / Q000009:adverse effects*; D019919:Prosthesis Implantation; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents