Jiro Sugita

The Detection of Bacteria and Bacterial Biofilms in Punctal Plug Holes

Purpose. An investigation into bacterial biofilm formation on and in punctal plugs. Methods. The study involved 21 patients with severe dry eye whose puncta were occluded by the use of punctal plugs. Of these, 15 had Sjögrens syndrome, 3 had non–Sjögrens syndrome, 2 had Stevens–Johnson syndrome, and 1 had graft-versus-host disease. From 17 of the 21 subjects, 18 samples of material were extracted from the holes of the punctal plugs (16 unilateral and 1 bilateral) and were subjected to enrichment culture. Nineteen punctal plugs were removed and processed for electron microscopy: 15 by scanning electron microscopy, and 4 by transmission electron microscopy. Results. Positive cultures were found in 8 of 18 (44%) samples of the material extracted from the holes of punctal plugs. In six of these eight cases (75%) the cultured bacterial species was Staphylococcus epidermidis, whereas in the other two cases (25%) it was S. aureus. In 8 of the 15 punctal plugs examined by scanning electron microscopy and in the material extracted from 1 plug that was examined by transmission electron microscopy, there was clear evidence of bacterial colonization. Conclusion. Careful observation of patients with punctal plugs is important. If material accumulates in or on a punctal plug, it may contain bacteria and may form a bacterial biofilm. In these cases, replacement of the plug, clearing of the hole, or an alternative treatment should be considered.

Acute conjunctivitis associated with biofilm formation on a Punctal plug

BACKGROUND Punctal plugs are used for the treatment of tear-deficient type dry eye. We recently examined a case of acute conjunctivitis associated with bacterial biofilm formation on a punctal plug. CASE A 63-year-old woman diagnosed as having tear-deficient type dry eye came to our hospital with a complaint of soreness in her right eye. Punctal plugs had been inserted into this eye 5 1/2 months previously. On the day of her visit, she presented with acute conjunctivitis. OBSERVATIONS In biomicroscopical examination, the top of the punctal plug was seen to be covered with a whitish soft material. Microbiological analysis performed on a part of this material was positive for Staphylococcus haemolyticus and Candida tropicalis. Scanning electron microscopy of the removed punctal plug revealed widespread bacterial colonization embedded within an extensive extracellular matrix. Treatment consisted of the replacement of the plug, and administration of a combination of antibacterial eyedrops and preservative-free artificial solution. As a result, the acute conjunctivitis cleared up within 1 month. CONCLUSIONS This case suggests that a punctal plug poses a potential risk of causing the formation of bacterial biofilm. In such a case, replacement of the plug and/or removal of the accumulated materials should be considered.

Canaliculitis caused by Actinomyces in a case of dry eye with punctal plug occlusion

BACKGROUND We report a case of canaliculitis caused by Actinomyces odontolyticus in a case of dry eye with punctal plugs. CASE A 64-year-old female with Sjögrens syndrome type of dry eye developed lacrimation, congestion in the lower palpebral conjunctiva and corneal epithelial damage in her right eye 30 months after punctal plug occlusion. After removal of the plug from lower punctum in her right eye, white material exuded from the punctum. However, even after the removal of a plug, corneal epithelial keratopathy did not get worse, implying that the granulation tissue formed by the plug completely occluded the canaliculus. Actinomices odontolyticus was cultured from the white material. One week after topical antibiotic treatment, conjunctival congestion and irritation were resolved. CONCLUSION This report indicates the possibility of canaliculitis as a complication of punctal plug occlusion. Careful observation is necessary after punctal occlusion with punctal plugs.

Outcome of punctal plug occlusion therapy for severe dry eye syndrome

PURPOSE Punctal occlusion using a silicone plug is one way of treating tear-deficient dry eye and it has been reported to be effective. We studied the outcome of punctal plug occlusion therapy for severe dry eye syndrome at our dry eye clinic. SUBJECTS AND METHODS Subjects were 76 eyes of 51 patients [6 eyes of 5 males, 70 eyes of 46 females, mean age: 58.6 +/- 13.4 (mean +/- standard deviation), 49 eyes of 30 patients with Sjögrens syndrome, 27 eyes of 21 patients without Sjögrens syndrome] with severe tear-deficient dry eye who underwent punctal occlusion using a silicone plug (Punctal plug, FCI Co. Ltd, France) during the period of Nov. 1996 to Mar. 2000 at our dry eye clinic. They were under observation for 632 +/- 405 days (mean +/- standard deviation). We studied if there is difference in tolerance between the sizes of punctal plug, compared epithelial damage before and after plug insertion, and studied relief in symptoms using self-assessment. RESULTS In tolerance of punctal plugs, 55.9% of all plugs were lost during our follow up, but there was no difference in time to loss between the sizes. Epithelial damage was reduced (p < 0.001). Dryness was the most reduced symptom: 26 patients (79%) got better, and only epiphora was increased, with 12 patients (36%) complaining slightly. CONCLUSION Punctal plug occlusion therapy for tear-deficient dry eye is conclusively very effective.

Observation of corneal epithelial disturbance through soft contact lens using fluorescein dextran.

Purpose. To confirm the usefulness of fluorescein dextran as a vital dye for observing corneal epithelial disturbance through a medical-use soft contact lens. Methods. Ten percent fluorescein isothiocyanate-dextran (FITC-dextran) was used as the staining dye. Patients with corneal epithelial disturbance who were wearing therapeutic soft contact lenses were observed using FITC-dextran. Results. Through the soft contact lens, FITC-dextran enabled corneal disturbance observation similar to that seen with sodium fluorescein. In a case of corneal perforation, as well, positive Seidels test was confirmed through the soft contact lens using this technique. Conclusion. FITC-dextran is considered a useful dye for examining the corneal epithelial condition without contact lens removal.

Observation of tear film in recurrent corneal erosion and epithelial basement membrane dystrophy.

Recurrent corneal erosion (RCE) is a common disorder that usually arises following specific trauma to the cornea, or epithelial basement membrane dystrophy (EBMD).1,2 Several studies on patients with RCE have been carried out light, electron or in vivo confocal microscopy.3–5 However, the tear film condition over abnormal elevated epithelium in RCE or EBMD patients is little understood.2 The present study evaluated the correlation between tear film and diseased corneal epithelium in patients with RCE or EBMD.