Punctal plugs for dry eyes: what they are, who they help, and who they don’t

What they are

Your tears drain away through two tiny openings at the inner corner of each eye, one in the upper lid and one in the lower. A punctal plug is a very small plug that sits in that opening and slows the drainage, so the tears you make stay on the eye for longer. Some dissolve on their own after a few months; others stay until they are removed.

Who they help

People who simply don’t make enough tears: aqueous deficient dry eye. That is more common as we get older, with some medicines, and with conditions such as Sjögren’s. If your tear volume is low, keeping what you do make on the eye can ease the dryness noticeably.

Who they don’t help

Most people with dry eye have enough tears, but blocked oil glands let them evaporate too quickly. Plugging the drain does not fix that, and keeping a poor-quality tear on an inflamed eye can make it feel worse. For that kind of dry eye, clearing the glands and calming the lids comes first. Every dry eye treatment, compared.

What having them is like

It takes a few minutes in the chair. Most people feel nothing more than a little pressure, and once they are in you should not notice them. Your eyes may water a little more at first.

Plugs or Lacrifill

Lacrifill is a newer option: a gel placed in the tear duct that does the same job as a plug. We offer both when your assessment shows your tear volume is low. Plugs £320, Lacrifill £520.

How we decide

At the Dry Eye Assessment (£145) we measure how much tear you make as well as how long it lasts. If the volume is low, we talk you through plugs or Lacrifill. If the problem is evaporation, we tell you that too, and what would help instead.

The short version

• Plugs keep your own tears on the eye for longer
• They help when you make too few tears
• They don’t fix blocked oil glands, the most common cause
• Plugs £320, Lacrifill £520, after an assessment shows low tear volume

Book a dry eye assessment