Complications of Freeman plugs.

Freeman punctal plugs (Eagle Vision, Memphis, Tenn) are becoming more popular and are a great improvement over the temporary collagen plugs used in treating dry eyes.1The advantage of punctal plugs over the collagen plugs is a total punctal occlusion that is also reversible. Two types of complications have been reported in four cases from the use of the Freeman plugs.2,3The first complication is loss of the plug in the canaliculus, either spontaneously or from excessive insertion force. The second complication is permanent punctal scarring after removal of the plug. Three cases involved the smaller Freeman plugs. Although it is important to be aware of these complications, they are quite rare. I have placed more than 200 Freeman plugs of various sizes with only three complications in the past 4 years, and both occurred with the larger "standard"-sized plug. Report of Cases. —Case 1. —A 55-year-old