Eyeworld

66 | EYEWORLD | JANUARY/FEBRUARY 2020 C ORNEA continued from page 65 Reference 1. Hadjiargyrou M, et al. Differ- ential bacterial colonization and biofilm formation on punctal occluders. Materials. 2019;12. Relevant disclosures Hadjiargyrou: None Perry: None Wang: None This image series shows a punctal occluder that is be- ginning to extrude and a closeup of another extruding plug. Lissamine green staining shows the irritation on the upper punctum from the plug in the lower punctum. Source: Henry Perry, MD continued on page 67 type were used for the staining, while the fourth one was used for SEM. The results There was an approximately three-fold sta- tistically significant difference detected in the quantity of S. aureus between the Odyssey and Alphamed occluders, with more found on the Odyssey, the researchers reported. There was an approximately two-fold difference between the Odyssey and Delta occluders, but it was not statistically significant. Using SEM, the Odyssey occluder appeared to be the smoothest one, followed by the Delta, which researchers described as "flat but not as smooth." The Alphamed occluder had a rough- er surface and four reservoir indentations. The use of higher magnification images showed the presence of individual bacteria in all three occluder types, with the Odyssey having the greatest amount and extent of colonization. Although there were bacteria on the Alphamed occluder, there was no detectable biofilm formation, just individual cells. Surprising results Researchers discussed a possible link between occluders and infections. "As bacterial infection is a rare but serious complication of punctal plug insertion, these findings lend credence to the possibility of oc- cluders being the source for recurrent conjunc- tival and canalicular infections due to biofilm adhesion, and in addition, may allow for a faster re-accumulation of biofilm on eyelids that have undergone a mechanical or electromechanical lid scrub. In essence, the occluders would act as a nidus for biofilm reformation with cloistered colonies of S. aureus," they wrote. It was not completely clear why the Odys- sey occluder had more bacterial growth. There may be a connection with its shape, which is designed to open inside the puncta and fit the shape of the tear duct. "It is possible that pooling of the material within this umbrella-like cavity leads to a statistically significant differ- ence in the quantity of bacteria when compared with the two other occluders," according to the study.

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