Bilateral simultaneous pyogenic granuloma after perforated punctal plug insertion.

A 44-year-old woman with recurrent attacks of bilateral adenoviral keratoconjunctivitis infections presented with excessive tearing of 5 months' duration. Slit-lamp examination showed bilateral punctal stenosis. Tearing improved for 2 months after insertion of perforated silicone punctal plugs, after which she had a bilateral foreign-body sensation due to pyogenic granuloma pushing through the lumen of the silicone plugs. The foreign-body sensation improved after removing the plugs and a short course of topical steroid-antibiotic eye drops.