Microbiologic Analysis of Removed Silicone Punctal Plugs in Dry Eye Patients

This study analyzed the microbiologic results of removing silicone punctal plugs due to uncomfortable symptoms in dry-eye patients. Patients who were diagnosed with dry eye and received silicone punctal plugs-SuperEagle Punctum Plug (TM) (EagleVision, Denville, NJ, USA) or Parasol Punctum Plug (TM) (Beaver-Visitec international, Inc., Waltham, MA, USA)-into upper or lower puncta that were removed due to discomfort from January 2018 to June 2020 were enrolled and reviewed retrospectively. Out of the total 58 patients (64 eyes), 19 patients were male and 39 patients were female. Protrusion without granulation (21 patients, 32.8%) was the most common reason for plug removal, followed by protrusion with granuloma (19 patients, 29.7%). The positive rate of bacterial culture was 42.2% and Klebsiella aerogenes was the most common organism identified (18.5%). Vancomycin showed the highest susceptibility of 100% among all the antibiotics, third-generation cephalosporins were the most susceptible (88.5%) among cephalosporines, and levofloxacin was the most susceptible (81.0%) among quinolones. Among the patients who complained of discomfort after insertion of silicone punctal plugs, approximately 42% had a positive result in bacterial culture. Therefore, when removing punctal plugs in such patients, a microbiological examination may be needed for the appropriate selection of antibiotics.