“Punctal plugs prevent tears from being moved to your nose and throat. This means that there is more tears available. They don’t make dry eyes worse, they only make more lubrication available in the eyes.”

When you have dry eye, inflammation proteins called cytokines are released. If you have cytokines in your tears, then punctal plugs may make the situation worse.

These situations can be helped by anti- inflammatory dry eye medications. They should be started at the same time as punctal plug placement.

“No. The actual production of tears doesn’t affect the plugs.”

The natural production of tears happens in your lacrimal glands — almond-shaped structures above the outer corners of your eyes — and accessory lacrimal glands underneath your eyelids.

“Punctal plugs are placed near the inner corner of your eyes, but they don’t affect these.”

The tears can stay around the eye for longer than if they were moved to the nose or throat.

The typical eyelid anatomy is required forunctal plugs to work. The punctal plugs will not have an effect if your eyelid is turned out.

“If inflammation or fast evaporation are causing your dry eyes, then punctal plugs alone won’t help.”

“The best plugs for dry eye areunctal. There aren’t enough tears to keep the eye moist.”

Ifunctal plugs work less well.

  • Your eyes are not normal.
  • There is inflammation in your eyes.
  • “Your tears don’t last long.”

Punctal plugs have immediate beneficial effects. People notice a change within a few days.

The mild soreness that can occur after the plugs are placed can go away in a few hours.

If the plugs rub against your eyes, you may feel a foreign body sensation.

Punctal plugs may make this worse if you have inflammation in your eyes, as the inflammation signals remain around the eye without being cleared.

When necessary,unctal plugs can be removed.

The removal usually involves a special tool. A healthcare professional will use a tool called a Fetus to remove plugs from a slit lamp in their office. Slit lamps use beams of light to look at your eyes.

A different design of punctal plug can be removed by using a solution of water and salt.

“These plugs eventually fall out on their own after about 6 months, so most of the time these measures aren’t necessary.”

If you or your doctor are concerned about how the plugs will be received, a collagen plug can be placed to check how much of an effect they will have. These plugs are made from dissolving protein and last a month.

If you experience worse foreign body sensation from the plugs rubbing against your eyes, you may want to remove them.

If an infection is suspected at the site of the plug or in the tear duct below it, a doctor may recommend removing the plugs.


Dr. Vicente Diaz is an ABMS board certified ophthalmologist at Yale Medicine and Yale Health who specializes in ocular inflammatory and infectious diseases. He is also the chief of ophthalmology at the Yale Health Plan and director of ophthalmology for the Bridgeport Hospital Burn Unit, where he oversees the care of all patients with Stevens-Johnsons syndrome, a rare and potentially lethal disease.