title: Plug surface defects as a late complication of silicone punctal plugs.
abstract: OBJECTIVE
  To report 3 cases of punctal plug surface defects as a cause of irritation complicating punctal plug therapy.
  
  
  METHODS
  Interventional case series and scanning electron microscopy (SEM) of punctal plugs.
  
  
  RESULTS
  Three patients were found to have punctal plug surface defects and local irritation of conjunctiva and inferonasal cornea 9, 40, and 69 months after placement of AquaFlo silicone punctal plugs for the treatment of dry eyes. SEM of the explanted plugs confirmed a defective collarette surface. In addition, unused AquaFlo plugs from different lots examined by SEM showed a rough irregular collarette surface that was not seen in unused plugs of Parasol silicone punctal plugs.
  
  
  CONCLUSIONS
  AquaFlo punctal plugs inherently have surface irregularities when compared with similar plug brands, which we suggest may predispose to plug breakdown over time, leading to mechanical irritation of the adjacent conjunctiva and cornea. This report highlights the local complications by AquaFlo punctal plugs associated with plug surface defects as a complication of punctal plug therapy.
authors.affiliation: Department of Ophthalmology, Summa Akron City Hospital, Akron, OH, USA.
authors.forename: Stella C
authors.initials: SC
authors.lastname: Paparizos
authors.forename: Deepak P
authors.initials: DP
authors.lastname: Edward
authors.forename: Smajo
authors.initials: S
authors.lastname: Osmanovic
mesh_terms: D000328:Adult; D003229:Conjunctival Diseases / Q000209:etiology*; D003316:Corneal Diseases / Q000209:etiology*; D015352:Dry Eye Syndromes / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D015590:Fluorophotometry; D006801:Humans; D007765:Lacrimal Apparatus / Q000601:surgery*; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D019736:Prostheses and Implants / Q000009:adverse effects* / Q000648:ultrastructure; D011475:Prosthesis Failure; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D012826:Silicone Elastomers / Q000009:adverse effects*
chemical_list: D009883:Ophthalmic Solutions; D012826:Silicone Elastomers