Chronic Canaliculitis and Granuloma from Suspected Retained Punctal Plug

We describe a rare case of delayed-onset canaliculitis with punctal granuloma formation caused by a punctal plug retained for decades following laser-assisted in situ keratomileusis. A 73-year-old woman presented with persistent left-eye redness and mucopurulent discharge unresponsive to topical therapy. Examination revealed a pedunculated granuloma at the lower punctum, although anterior segment optical coherence tomography did not detect any foreign material. Surgical excision with canalicular exploration uncovered cream-coloured concretions containing a central hard core that was firm and non-crushable, consistent with longstanding retained foreign material. Histopathology demonstrated chronic inflammation with eosinophilic amorphous material, while cultures grew Fusobacterium species and Streptococcus anginosus , suggesting biofilm-associated infection. The patient recovered uneventfully and further canalicular assessment is planned. This case highlights the potential for extremely delayed complications of punctal plug retention and emphasises the need for clinical suspicion in patients with chronic conjunctivitis and a remote history of plug insertion.