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The short version
- A punctal plug is about the size of a grain of rice. It blocks an opening your tears drain through, which keeps more of your own tears on the eye and helps lubricating drops keep working longer.
- Plugs make the most sense when your eyes make too few watery tears. Whether they help evaporative dry eye, where the eyelid oil glands are the problem, is unclear.
- Dissolving plugs last from days to months and are often used as a trial run. Silicone and other long-lasting plugs are designed to stay in for years and can be removed.
- Randomized trials haven’t shown a clear benefit, and a Cochrane review of 18 trials called the results inconclusive. Reviews that include observational studies are more encouraging.
- Plugs falling out, watery eyes and irritation are the common problems. Infections are less common and more likely with plugs placed deep in the tear canal.
- Before you book, ask which type you’re getting, how it would come out, and for a written estimate.
What punctal plugs are and how they work
Your tears drain away through tiny openings in your upper and lower eyelids called puncta. A punctal plug, about the size of a grain of rice, blocks one of these openings so tears stay on the surface of your eye and keep it moist1 American Academy of Ophthalmology, 2026 (opens in a new tab). Punctal Plugs..
Plugs usually go in the openings of the upper or lower eyelids, or both. Another type goes deeper into the drainage canal behind the opening, called the canaliculus, where it can’t be seen at all1.
Plugs work by holding on to tears. They preserve your natural tears and make the effect of lubricating drops last longer2 Jehangir et al., Journal of Ophthalmology, 2016 (opens in a new tab). Comprehensive review of the literature on existing punctal plugs for the management of dry eye disease.. That’s why they fit best when the problem is too few tears.
Types of plugs and how long they last
Plugs are grouped by how long they last and by where they sit2.
- Short-term dissolving plugs. These are usually made of collagen. Estimates of how long they last vary: one review puts it at 4 to 14 days2, while the 2017 TFOS DEWS II report from an international dry eye workshop says collagen plugs dissolve in one to 16 weeks3 Jones et al., The Ocular Surface, 2017 (opens in a new tab). TFOS DEWS II Management and Therapy Report.. They’re typically used as a test, to find out whether blocking the drains helps before longer-lasting plugs go in3. A short trial also helps show whether plugs are likely to leave your eyes watery2.
- Longer-lasting temporary plugs. Made of synthetic materials, these last about two to six months. They’re used for dry eye, after laser vision correction such as LASIK, and to help eye medicines stay on the eye longer2.
- Long-lasting plugs. Most plugs that sit in the opening are made of silicone2. Silicone and acrylic plugs are designed to stay in for years, and your eye doctor can remove them if needed1. Some silicone plugs have a channel through them that may still let some tears drain3.
Where a plug sits matters too. A plug that rests in the opening is easy to see and can usually be removed without much difficulty. A plug placed inside the canal can’t be seen and is unlikely to fall out, but it’s more likely to move deeper, and it can be hard to locate without an ultrasound scan2.
Closing the openings for good. The most common way to close a tear drain permanently is to seal it with heat, called punctal cautery. It’s generally reserved for people whose symptoms improved with temporary plugs but who couldn’t keep longer-term plugs in or tolerate them4 TFOS DEWS III, American Journal of Ophthalmology, 2025 (opens in a new tab). TFOS DEWS III: Management and Therapy..
Sealed openings can reopen. A 2024 review found nine studies with 150 people in all, none with a comparison group. Depending on the study, reopening rates ranged from 0% to 38.7% after heat cautery and from 5% to 9% after surgical closure. The authors called for randomized trials5 Ranjan et al., The Ocular Surface, 2024 (opens in a new tab). Punctal cautery in dry eye disease: a systematic review..
Gel fillers. A newer option fills the canal with a gel. In a randomized trial of 157 people, a cross-linked hyaluronic acid gel (Lacrifill) was found to be no worse than a hydrogel canal plug for gains in tear production and for the share of people whose symptom scores improved meaningfully, with improvements lasting through six months4.
Dextenza is a medicine. It goes into the lower tear drain opening and the canal behind it, like a canal plug, but it’s a steroid insert that releases dexamethasone for up to 30 days and is absorbed by the body. Its FDA label covers eye inflammation and pain after eye surgery, and eye itching from allergic conjunctivitis. Dry eye isn’t one of the uses on its label6 FDA prescribing information: Dextenza, via DailyMed (opens in a new tab). DEXTENZA (dexamethasone ophthalmic insert)..
Who plugs suit and when they don’t
Plugs make the most sense for aqueous-deficient dry eye, where the tear glands don’t make enough of the watery part of your tears. Our guide to the two main types of dry eye explains the difference. The workshop’s latest report, TFOS DEWS III from 2025, describes plugs as a recognized treatment for moderate to severe dry eye of this kind4.
For evaporative dry eye, where problems with the eyelid oil glands let tears evaporate too fast, the earlier DEWS II report called the use of plugs controversial and the results unclear3. Oil gland problems are typically treated with warm compresses and a range of in-office treatments4.
DEWS II also listed other conditions where plugs are a reasonable option because keeping more tears on the eye may help3:
- Dryness from wearing contact lenses
- Dry eye after laser vision correction
- Dry eye linked to Sjögren’s syndrome, other autoimmune diseases or graft-versus-host disease
- Dryness from medicines that reduce tear production. Don’t stop a prescribed medicine because of your eyes; ask the prescriber first.
- Eyelids that don’t close fully
- Scarring or an irregular surface on the cornea that makes the tear film unstable
For contact lens wearers the evidence is mixed. A 2015 American Academy of Ophthalmology review of observational studies reported more comfortable lens wear with plugs7 Marcet et al., Ophthalmology, 2015 (opens in a new tab). Safety and efficacy of lacrimal drainage system plugs for dry eye syndrome: a report by the American Academy of Ophthalmology.. But in one randomized trial in contact lens wearers with dry eye, symptoms improved about as much with a sham procedure as with plugs. The review that describes it says this may mean the plugs didn’t help, or that a benefit was missed, for example because the trial was small or plugs fell out2. Our guide to dry eyes with contact lenses covers other changes that may help.
When plugs aren’t a good idea. A review of plug research lists allergy to the plug material, a blocked tear drainage system, an eyelid that turns outward (ectropion) and an active eye infection as reasons not to use them. It adds that severe inflammation of the eye surface or eyelids, such as blepharitis, should be treated before plugs go in2.
The concern is that blocking the drains could, in theory, keep inflammatory substances on the eye longer. For that reason DEWS II called plugging an inflamed eye controversial and recommended treating the inflammation first, though it noted a three-week study of 29 people with moderate dry eye that found less surface staining and lower symptom scores, with no rise in those substances3.
The free Dry Eye Profile sorts your symptoms into a likely type and gives you a plan in about three minutes.
Where plugs fit in dry eye care
The 2017 DEWS II report set out dry eye treatment in four steps, which it said weren’t meant to be followed rigidly. Punctal plugs were a step 2 option, to consider if step 1 wasn’t enough. Step 1 included learning about the condition, changing your surroundings, lubricating drops, lid hygiene and warm compresses. Step 2 also included preservative-free drops, moisture goggles, overnight treatments, in-office treatments for the oil glands and prescription medicines. Surgical closure of the tear drains was a step 4 option3.
The 2025 DEWS III report takes a different approach. It says sorting patients into stages, such as steps 1 to 4 or mild to severe, isn’t the best fit for dry eye, because several causes can be at work at once and can change over time. Instead it matches each treatment to the cause. It describes using several treatments together as the likely and most appropriate approach4.
The American Academy of Ophthalmology suggests talking with your ophthalmologist about plugs if artificial tears or other eye drops haven’t relieved your symptoms1. Expect plugs to be one part of a plan: DEWS II noted that they may work best when combined with other dry eye treatments3. Our guide to dry eye treatments beyond drops covers the other options, and prescription dry eye drops compares the medicines.
What happens when plugs go in
Your eye doctor first examines your eyes to choose the best type and size of plug. The tear drains may be numbed, though in some cases that isn’t needed, and you may feel some pressure as the plug goes in. You can usually go back to your normal activities right away1.
What the research found
Mixed evidence The research on plugs points in two directions, depending on how the studies were done.
Randomized trials haven’t shown a clear benefit. A 2017 Cochrane review found 18 trials with 711 people (1,249 eyes) and judged them at unclear risk of bias because they were poorly reported. In the three trials that compared plugs with no plugs and reported symptoms, plugs made little or no difference to symptom scores, and the certainty of that evidence was very low. Single trials gave low-certainty evidence of slightly less staining of the eye’s surface (a sign of damage), a difference the reviewers called small and possibly clinically unimportant, slightly steadier tears, and less frequent use of artificial tears8 Ervin et al., Cochrane Database of Systematic Reviews, 2017 (opens in a new tab). Punctal occlusion for dry eye syndrome..
In trials that compared plugs with artificial tears, low-certainty evidence suggested little or no difference in surface staining or tear production. The reviewers called the overall results inconclusive, partly because the trials used different plugs and enrolled people with different types and severities of dry eye8. The 2025 DEWS III report summarizes the review the same way4.
Reviews that include observational studies are more encouraging. The 2015 American Academy of Ophthalmology review covered 27 studies, all of them observational. It reported that plugs improved symptoms by 50% or more, improved the health of the eye’s surface, cut artificial tear use and made contact lenses more comfortable. It concluded that plugs help moderate dry eye that lubricating drops haven’t improved, while noting there were no studies at the highest level of evidence7. A 2025 meta-analysis that pooled 17 randomized and cohort studies with 1,658 patients also reached a positive conclusion, with improvements in tear stability, tear production, symptom scores and surface staining. Its authors noted a moderate risk of bias in some of the cohort studies9 Chen et al., Contact Lens & Anterior Eye, 2025 (opens in a new tab). How effective and safe are punctal plugs in treating dry eye disease? A systematic review and meta-analysis..
We grade plugs as mixed on our evidence board of dry eye treatments: encouraging in observational studies, unproven in the randomized trials. Dissolving plugs wear off on their own, which makes them a way to find out whether plugs help you before committing to longer-lasting ones3.
Side effects and complications
The most common side effect is a scratchy or irritating feeling in the corner of the eye. Many people find it goes away, or they get used to it. Other possible problems, according to the American Academy of Ophthalmology1:
- Watery eyes. Plugs can leave your eyes too watery. The plugs may need to come out, or be swapped for a different type.
- Plugs that move or fall out, usually from rubbing your eyes.
- A plug that sticks out of the opening and rubs against your eye or eyelid, if it doesn’t fit well.
- Irritation of the tear duct, with redness and swelling. Ongoing inflammation can scar or damage the duct.
- Infection. The academy calls this rare. Some infections may need antibiotics, and your eye doctor may want to remove the plugs.
How often. In the 2015 academy review, the most commonly reported problem with plugs that sit in the opening was plugs falling out, in 40% of patients on average. Across all types of plugs, about 9% of people had watery eyes and 10% needed a plug removed because it irritated the eye7.
In the same review, the most commonly reported problem with plugs placed in the canal was infection of the canal (canaliculitis), in about 8% of patients. Other problems, including an overgrowth of tissue called pyogenic granuloma and inflammation of the tear sac (dacryocystitis), were reported in under 4% of patients on average, and serious complications were infrequent7.
DEWS II says plugs coming out on their own is the most common complication and may happen in as many as 60% of cases. It also says infections are more common with plugs placed in the canal3. When a plug falls out completely, the opening can be left larger, which makes the next plug more likely to fall out too2.
Tell your eye doctor right away if you have
Eye pain or scratchiness, or signs you think could be an eye infection. Your doctor may decide to remove the plugs1.
Getting plugs removed
Dissolving plugs gradually break down and are absorbed by the body. Silicone plugs can be gently pulled out with forceps, or flushed out with a saltwater solution, which pushes them through the tear duct into the nose or throat. The academy says plugs that sit deeper, in the canal, are removed with surgery1.
Deep plugs can be stubborn. In one study of infections linked to SmartPlug canal plugs, symptoms appeared about three years after the plug went in, on average. Flushing failed to remove the plug every time, and every eye needed surgery2. So before you agree to plugs, ask whether yours will sit in the opening or in the canal, and how it would come out if it caused trouble.
Cost and insurance
We haven’t found a reliable published source for typical US prices, so we don’t quote one. Before you book, ask the practice for a written estimate that covers:
- The visit and the plugs, and whether the price is per plug, per eye or for both eyes
- Whether it’s billed to your medical insurance or your vision plan, and the billing code, so you can ask your insurer what it covers
- The cost of replacing a plug that falls out
- The cost of removal, if you ever need it
Questions to ask before you get plugs
Which type of dry eye do I have, and why do you think plugs will help? Are these dissolving or long-lasting plugs? Will they sit in the opening or in the canal, and how would they come out? Upper openings, lower or both? What should I do if my eyes start watering or a plug falls out? What will it cost in total?
Our directory lists practices whose own websites show dry eye care beyond drops, and you can filter the list for punctal plugs. Search by ZIP code, starting in Florida.
Common questions
How long do punctal plugs last?
It depends on the type. Short-term collagen plugs last days to weeks: one review says 4 to 14 days, and the DEWS II report says one to 16 weeks. Longer-lasting temporary plugs last about two to six months, and silicone or acrylic plugs are designed to stay in for years unless they fall out or are removed.
Can punctal plugs fall out?
Yes. It’s the most commonly reported problem with plugs that sit in the opening: in a 2015 review they fell out in 40% of patients on average. When plugs move or come out, it’s usually from rubbing your eyes. Your eye doctor can check whether a plug is still in place and talk about replacing it. If plugs help but won’t stay in, sealing the opening with heat is an option.
Are punctal plugs permanent?
Not necessarily. Even long-lasting silicone plugs can fall out or be removed. Permanent closure means sealing the opening itself, most often with heat. It’s generally reserved for people who were helped by temporary plugs but couldn’t keep longer-term plugs in or tolerate them, and sealed openings sometimes reopen.
Do punctal plugs help evaporative dry eye?
It’s unclear. Plugs hold on to watery tears, so they make the most sense when the eyes make too few. For evaporative dry eye, where problems with the eyelid oil glands let tears evaporate too fast, the DEWS II report called their use controversial with unclear results. Oil gland problems are typically treated with warm compresses and in-office treatments.
Do punctal plugs hurt?
Your eye doctor may numb the area first, though not always, and you may feel some pressure as the plug goes in. Afterward, the most common side effect is a scratchy feeling in the corner of the eye, which for many people goes away or stops bothering them. Tell your eye doctor right away about eye pain or signs of an infection.
Is Dextenza a punctal plug?
No. Dextenza goes into the lower tear drain opening and the canal behind it, but it’s a medicine: a tiny insert that releases the steroid dexamethasone for up to 30 days and is absorbed by the body, so it doesn’t need to be removed. Its FDA label covers eye inflammation and pain after eye surgery and eye itching from allergic conjunctivitis. Dry eye isn’t one of its listed uses. Steroids can raise the pressure inside the eye, so its label says eye pressure should be monitored during treatment.
Sources
- Punctal Plugs (opens in a new tab). American Academy of Ophthalmology, 2026.
- Comprehensive review of the literature on existing punctal plugs for the management of dry eye disease (opens in a new tab). Jehangir et al., Journal of Ophthalmology, 2016.
- TFOS DEWS II Management and Therapy Report (opens in a new tab). Jones et al., The Ocular Surface, 2017.
- TFOS DEWS III: Management and Therapy (opens in a new tab). TFOS DEWS III, American Journal of Ophthalmology, 2025.
- Punctal cautery in dry eye disease: a systematic review (opens in a new tab). Ranjan et al., The Ocular Surface, 2024.
- DEXTENZA (dexamethasone ophthalmic insert) (opens in a new tab). FDA prescribing information: Dextenza, via DailyMed.
- Safety and efficacy of lacrimal drainage system plugs for dry eye syndrome: a report by the American Academy of Ophthalmology (opens in a new tab). Marcet et al., Ophthalmology, 2015.
- Punctal occlusion for dry eye syndrome (opens in a new tab). Ervin et al., Cochrane Database of Systematic Reviews, 2017.
- How effective and safe are punctal plugs in treating dry eye disease? A systematic review and meta-analysis (opens in a new tab). Chen et al., Contact Lens & Anterior Eye, 2025.
This guide is for education and doesn’t replace an eye exam. Your eye doctor can tell you whether plugs suit your eyes and which type to use.