Lesson Summary

Complications with punctal occlusions are uncommon but important to recognize. The primary complications include:

• Epiphora: Constant tearing or watery eyes, with patients feeling tears dripping down their cheeks.
  • If all four puncta are occluded, consider removing two plugs.
  • If only the bottom two are occluded, irrigate the plugs to assess patient response.
• Plug extrusion: Occurs when plugs stick out or fall out, usually due to inappropriate sizing.
  • Smaller plugs in larger puncta increase the risk of extrusion.
  • Replace the plug with a properly sized one and reassure the patient.
• Cannuliculitis: Inflammation or infection in the canalicular area.
  • Treat by removing the plug and using medication.
  • Oral antibiotics are often preferred over topical for lid issues, but clinical judgment is necessary.
• Pyogenic granuloma: A red, fleshy growth at the punctum, more common with permanent punctal plugs.
  • Considered a significant reason some optometrists avoid permanent plugs.
  • Typically requires surgical referral to an ocular plastic surgeon.
  • Leads to patient dissatisfaction and can be challenging to manage.
• Migration into the canaliculus: When the plug moves into the canaliculus and is no longer visible.
  • Assessment becomes difficult and symptoms may worsen.
  • Irrigate the plug out depending on patient's symptoms.

While these complications are not common, it is essential to be aware of them for effective management and patient care.