Objective: To evaluate the long-term complication associated with the use of the Smart plug in the treatment
of aqueous tear deficiency dry eye. Methods: A total of 300 patients (600 eyes) were collected in Joint Shantou
International Eye Center from 2011 to 2016, all the patients accepted the treatment with Smart plug, and were
followed up for clinical complications. The median follow-up time was postoperative 3 years (1–5 years after
surgery). Results: Three patients (3 eyes) developed canaliculitis, the rate was 0.5%. The median time from
Smart plug insertion to the onset of canaliculitis was 2 (1–3) years, leaving the Smart plug and resolved the
application of topical antibiotics. Two patients (4 eyes) could not suffer from implantation of the upper and lower
Smart plug, removed the below, the ratio was 0.7%; 4 patients (8 eyes) need upper Smart plug insertion after
implantation of the lower one month later, the rate was 1.3%; 291 cases of dry eye improved by long-term followup,
the effective rate was 97.5%. Conclusion: Although the Smart plug is effective in the treatment of aqueous tear deffciency dry eye, the later complications of Smart plug insertion cannot be neglected and need the long-term
follow-up.