PURPOSE: To report on an uncommon, previously unidentified, progressive silicone punctal plug extrusion. DESIGN: Small, retrospective case series. PARTICIPANTS: 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.
PURPOSE: To report on an uncommon, previously unidentified, progressive silicone punctal plug extrusion. DESIGN: Small, retrospective case series. PARTICIPANTS: 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.