To describe a case of keratoconjunctivitis sicca treated with punctal plug placement with the first reported complication of subsequent plug erosion through the canaliculus and extrusion through the lid.
Punctal plugs were placed in a patient with Sjogren syndrome for treatment of keratoconjunctivitis sicca. More than 12 years later, the plug was noted to have eroded through the canaliculus and extruded through the conjunctiva and lid.
The extruded plug was removed, and punctal cautery was performed on 2 other puncta with improved symptom control.
Plug extrusion through the conjunctiva and lid is a possible consequence of punctal plug placement.