Evaluation of the Microbiology of Removed Punctal Plugs and Intracanalicular Devices

Abstract

Objective: The purpose of this observational study was to characterize the microorganisms colonizing punctal plugs and intracanalicular stents. Methods: Devices were removed from participants who previously underwent placement of punctal plugs for tear insufficiency and lacrimal stents for dacryocystorhinostomy and canalicular reconstruction procedures. After removal of the devices, they were cultured for organisms both with and without sonication to loosen any biofilms or adherent microorganisms. Primary outcome measures included culture positivity, identification of isolated microorganisms, recovery of microorganisms from culture after sonication, and clinical evidence of ocular infection. Results: There were no cases of clinical infection. A total of 181 specimens were processed (174 punctal plugs, seven intracanalicular stents), of which 98 (54%) were culture positive. Of the punctal plugs, 92 (52.9%) were culture positive, including 42 with a single organism isolated, whereas 22 yielded two organisms, 7 yielded three organisms, and the remaining 21 yielded a polymicrobial culture with four or more organisms. The most common isolates from punctal plugs were coagulase negative staphylococci (27.6%), diphtheroids (16.4%), and streptococcus viridans (10.2%). Those plugs with polymicrobial culture results grew a mixture of organisms most consistent with skin or upper respiratory flora. Of the intracanalicular stents, 6 (85.6%) were culture positive. Conclusions: Punctal plugs and intracanalicular devices can become colonized with bacteria composed of oropharyngeal flora, skin flora, and other rare but potentially significant pathogens.