Illustration of a SmartPlug punctal plug partially extruded from a tear duct.

SmartPlug Woes: A Cautionary Tale of Punctal Plug Extrusion

Avery Sinclair in Health & Wellness December 2025 • 4 min read.

"When Dry Eye Relief Turns Problematic: Understanding the Risks and Management of SmartPlug Complications"

Punctal plugs have become a common solution for managing dry eye, offering a reversible alternative to permanent punctal occlusion. Among these, the SmartPlug, known for its unique temperature-sensitive expansion, has gained popularity.

While generally considered safe, complications can occur. A recent case study sheds light on a rare but significant issue: SmartPlug extrusion through the canalicular mucosa, the delicate lining of the tear duct.

This article delves into this specific case, exploring the symptoms, diagnosis, and management of SmartPlug extrusion, providing valuable insights for patients and practitioners alike.

The Case: When Dry Eye Relief Went Wrong

Illustration of a SmartPlug punctal plug partially extruded from a tear duct.

A 62-year-old woman, previously diagnosed with Sjogren's syndrome and severe dry eye, visited an ophthalmology clinic with complaints of worsening redness and discharge in her right eye. She had a history of SmartPlug insertion in both eyes – 12 years prior in the left and 9 years prior in the right – to manage her dry eye symptoms.

Upon examination, doctors noted swelling, redness, and tenderness around the lower punctum (the opening of the tear duct) in her right eye. Irrigation of the lacrimal system suggested a partial obstruction, accompanied by mucopurulent discharge. Closer inspection revealed a small, yellowish foreign body protruding from the canalicular mucosa beneath the punctum.

The foreign body was identified and carefully removed, leaving behind a small defect in the mucosa.
The foreign body was identified as the SmartPlug.
The patient was treated with topical antibiotics and ointment.
Within four weeks, her symptoms completely resolved.

This case highlights a rare complication where the SmartPlug, instead of remaining within the tear duct, eroded through the delicate canalicular mucosa and partially extruded. While the exact mechanism remains unclear, potential factors include inflammation, mechanical irritation, or even the formation of pyogenic granulomas (inflammatory growths).

What Does This Mean for SmartPlug Users?

This case serves as a reminder that, while generally safe and effective, SmartPlug insertion is not without potential complications. Patients with a history of SmartPlug insertion should be aware of the signs and symptoms of extrusion, including persistent redness, discharge, swelling, or discomfort around the punctum.

If you experience any of these symptoms, prompt evaluation by an ophthalmologist is crucial. Early diagnosis and treatment can prevent further complications and ensure the best possible outcome.

While SmartPlug extrusion is rare, this case underscores the importance of vigilance and awareness among both patients and eye care professionals. By understanding the potential risks and recognizing the signs of complications, we can optimize the safety and efficacy of dry eye management with punctal plugs.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.3341/jkos.2017.58.4.459, Alternate LINK

Title: A Case Of Smartplug Partial Extrusion Through Canalicular Mucosa

Subject: Ophthalmology

Journal: Journal of the Korean Ophthalmological Society

Publisher: Korean Ophthalmological Society

Authors: Hwa Su Choi, Seung Ki Lee, Jong Seok Park, Sung Jin Kim

Published: 2017-01-01

Everything You Need To Know

What is the purpose of a SmartPlug and how does it relate to the issues described?

SmartPlugs are designed to help with dry eye by blocking the tear drainage system. This increases the amount of tears on the eye's surface, providing relief from dryness. In this scenario, the SmartPlug, intended to stay within the tear duct, instead extruded through the delicate canalicular mucosa, leading to the patient's symptoms.

What are the typical symptoms of SmartPlug extrusion?

The key symptom of SmartPlug extrusion is persistent redness, discharge, swelling, or discomfort around the punctum, which is the opening of the tear duct. The case describes a 62-year-old woman who experienced worsening redness and discharge in her right eye after having SmartPlugs inserted to manage dry eye. These symptoms prompted her to seek medical attention, leading to the diagnosis of SmartPlug extrusion.

What does it mean if a SmartPlug extrudes, and what are the implications?

SmartPlug extrusion is a rare complication where the SmartPlug moves out of its intended position within the tear duct and pushes through the canalicular mucosa. This can happen due to various factors, including inflammation, mechanical irritation, or the development of inflammatory growths. The implications include potential pain, discharge, and the need for medical intervention to remove the SmartPlug and treat the affected area.

How is SmartPlug extrusion diagnosed?

The diagnosis of SmartPlug extrusion involves a thorough examination of the eye. Doctors examine the area around the punctum, the opening of the tear duct, for signs like redness, swelling, and discharge. Irrigation of the lacrimal system can help identify any obstructions. In the case study, a yellowish foreign body was seen protruding from the canalicular mucosa, confirming the extrusion of the SmartPlug.

What is the recommended course of action if a SmartPlug extrusion is suspected?

If a SmartPlug extrusion is suspected, it requires medical attention. The SmartPlug must be removed to alleviate the symptoms. After removal, treatment may involve topical antibiotics and ointments to prevent or manage any infection and promote healing. The patient in the case study fully recovered after the SmartPlug was removed and treated with these methods.