Silicone punctal plug migration resulting in dacryocystitis and canaliculitis

Purpose. One of the modalities of treating dry eyes is punctal plugs. They are usually used for temporary occlusion of the lacrimal drainage system. Among the complications associated with silicone punctal plugs are extrusion, downward migration, irritation, and epiphora. To our knowledge, this is the first report of dacryocystitis and canaliculitis as a result of spontaneous migration of punctal plugs into the lacrimal drainage system. Methods. We describe the sequelae of spontaneous migration of silicone punctal plugs into the lacrimal drainage system in two patients with dry eyes. Results. In two patients, spontaneous migration of silicone punctal plugs into the canaliculus or the lacrimal sac, respectively, resulted in canaliculitis or dacryocystitis. Conclusion. Smaller sized newer generation punctal plugs were designed to facilitate insertion; however, this design also increases the likelihood of proximal migration within the lacrimal drainage system. The importance of monitoring patients after punctal-plug placement cannot be overemphasized.