涙小管結膜瘻ののちに自然脱落した涙点プラグ脱出の1例

A case of spontaneous extrusion of punctual plug through a lacrimal fistula

要約　目的：涙小管に涙点プラグ挿入を受けたのち，涙小管結膜瘻を通じてプラグが脱落した症例の報告。症例：64歳女性が4年前にドライアイと診断され，2か月前に左眼の下涙点にスーパーイーグルプラグ^®の挿入を受け，症状が改善した。その2か月後の受診で，プラグ先端部が瞼結膜側に瘻孔を作って脱出していたので，当科に紹介された。所見：受診時にプラグは脱落していた。結膜囊内と涙小管内にはプラグはなく，瘻孔は自然閉鎖していた。涙点閉鎖術を行い，以後の経過は良好である。結論：スーパーイーグルプラグ^®のような段差が強い涙点プラグを挿入したのちには，これが穿孔脱落することがある。

Abstract.　Purpose：To report a case who received insertion of lacrimal plug that later extruded through a lacrimal fistula. Case：A 64-year-old female had been diagnosed with dry eye 4 years before. Subjective simptoms reportedly improved after insertion of a lacrimal plug in the lower lacrimal punctum in her left eye 2 months before. She was referred to us after the plug was found protruding through a fistula in the palpebral conjunctiva. Findings：The plug was absent when seen by us. The lacrimal fistula had closed spontaneously. She was treated by surgical closure of lacrimal puncta and has been doing well subjectively and objectively. Conclusion：This case illustrates that a lacrimal plug may spontaneously extrude after insertion.