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Sjogren’s and Punctal Plugs: Pros and Cons


Punctal plugs have both pros and cons. The pros are that they are a safe method to retain tears on the ocular surface and have value in relieving symptoms when tear production is borderline or if the duration of applied tear substitutes needs to be prolonged. They are helpful as adjunctive treatment in the management of dry eye disease.

The cons are that when applied in the presence of inflammation that can occur as part of dry eye disease, they may aggravate symptoms by allowing the inflamed tear to have prolonged contact with the surface of the eye. Therefore, my recommendation is to treat the underlying inflammation before placing the plugs. Another con is that they can fall out and need frequent replacement. Rarely, the plug can provoke a localized inflammatory reaction in the tissue of the eyelid and produce a granuloma at the opening of the tear drainage puncta.

On balance, punctal plugs are a useful adjunctive treatment for dry eye disease but should be used in conjunction with other therapies to control inflammation.

By Gary Foulks, MD


do you need to use Restasis with the plugs?
Posted @ Tuesday, May 01, 2012 11:51 AM by Linda Percival
In response to above...I think it depends on how severe your dry eyes are. For me, after getting punctal plugs I do not require re-wetting drops near as often. Restasis is something that you have to use daily all the time. Each individual is unique in their needs. While it worked great for me, it may not be right for you. It is best to check with your ophthalmologist to see if punctal plugs would be ideal for you. And if you haven't had a Schirmer test done, it would be a good time to get that done as well! That test will tell you just how dry your eyes really are. Best of luck to you!
Posted @ Tuesday, May 01, 2012 12:16 PM by April
Okay, I have Sjogren's and sarcoidosis; does this increase my risk of the granuloma?
Posted @ Tuesday, May 01, 2012 3:09 PM by Dianne
I use allergy drops and Restasis. I also have plugs top and bottom. Now I am really comfortable! Just hope they stay in!
Posted @ Tuesday, May 01, 2012 4:13 PM by Sherrym Thiesen
I was fortunate to work for optometrists when my Sjogren's was diagnosed. The punctal plugs have been wonderful preventative measure against frequent corneal scratches. Personally, I strongly recommend this treatment though this article does confirm the need for frequent attention from the eye doctor!
Posted @ Tuesday, May 01, 2012 6:04 PM by Terri Barnhart
I use allergy drops and Restasis. Instead of plugs, which I found a bit irritating, I went the whole hog and had my tear ducts cauterized: both ducts in the left eye, one in the right. I'm pretty comfortable, but still need the artificial tears during the day and Refresh Lacri-Lube ointment at night. I found Restasis to be a major help. Muro 128 solution and ointment also keep corneal abrasions away. I guess I'm a bad case! 
Posted @ Tuesday, May 01, 2012 10:44 PM by Barbara Dinerman
I've had a punctual plug in my right eye for over a year and the plug in my left eye replaced after 6 months. The lower ducts only. I use eyedrops less, and I don't notice the plugs in my ducts anymore. They are comfortable and they work.
Posted @ Wednesday, May 02, 2012 4:22 PM by Jennie
I am currently having pain in saliva glands, teeth sensitivity and ear pain. What have others done to control pain? Anbesol helps some. Any ideas? Thanks
Posted @ Thursday, May 03, 2012 11:12 PM by Vickie Allmand
After using many eye drops and still useing 
Restasis three times a day for over a year, I had bottom plugs inserted 6 months ago. I feel I use less over the counter drops, but when I have a flare up it is still bad.  
Myrna, ML
Posted @ Monday, May 07, 2012 5:02 PM by Myrna, ML in Vermont
I have plugs on both of my eyes (the lower lids). I also use restasis and Genteal drops 3 - 4 times a day. I also use warm compress. Yet my eyes are still dry. My eye doctor might prescribed another medication.
Posted @ Tuesday, June 26, 2012 8:28 PM by Avis Stein
My plugs kept falling out. I tried cauterization, but the punctals kept reopening. I finally had all four punctal openings surgically closed. Great solution!
Posted @ Sunday, July 22, 2012 12:47 PM by Ann
Has anyone noticed having a dry nose after having their tear ducts plugged or closed? 
Posted @ Tuesday, July 24, 2012 10:59 PM by Jennie
I have had plugs and tend to have to have larger ones every two to three months as they pop out when I have a bad sinus infection and use a nasal rinse to clear the infections. I have an eye doctor who is willing to see me every three to four weeks to instal new plugs. They relieve the gravel feeling in my eyes and I do use the recommended gels and drops to keep me going through the day. I also wear prescription goggles during outside trips on windy, hot days or when working in a dusty place. They have been a great help in keeping the pollens and other allergens out of my eyes. Now if they could solve the problems between close and distance vision I would be happy.
Posted @ Wednesday, August 08, 2012 5:51 AM by Dorothea
I have sjogrens, skin lupus and treated with hydroxycloraquin sulf 
anso far the skin is clearing and the eyes are healing just watering. 
I had cataract surg. with the restore lens and the Dr piggy backed the right eye twice and caused the scratches of which I am going to another DR, all this is auto immune and I had graves 31 years ago an also had the salvia gland surg. with 22 tumors, benign.
Posted @ Wednesday, August 08, 2012 3:48 PM by dee farkas
am about to have plugs in both eyes to help my sjogrens - not sure what to expect
Posted @ Thursday, August 09, 2012 2:41 PM by leigh
I had plugs (lower) in both eyes but one fell out and scar tissue took over - just like having the plug. I do struggle at night with dry mouth -the gums and lozanges don't work well. On visit to my dentist I had 7 cracked teeth, which led to my diagnosis.
Posted @ Tuesday, September 04, 2012 5:42 PM by Sally
Many of the punctal plugs are made of silicon. Silicon has been shown to cause autoimmune disorders like Sjogren's. As I have already have Sjogren's I don't need an exacerbation. google Silicone-reactive disorder NIH for more info.
Posted @ Wednesday, October 31, 2012 11:12 AM by Dana
I have Sjogrens and dry eyes. I've had to stop wearing my hard contact lenses and stick to glasses and I was put on Restasis but after two months my right eye started to turn and would stay that way for a bit. I got scared and told my doctor I was not going to use it anymore. He then inserted the Punctum Plugs and I've had good results since. Now I just use OPtiva Advanced twice a day and I really feel much better on a daily basis.
Posted @ Thursday, November 01, 2012 6:01 PM by LYDIA M PEREZ
I signed up for the "My Tears My Rewards" program with Restasis, in order to get reduced cost drops. If you go to this website, you'll see it says "Restasis did not increase tear production in patients using anti inflammatory eye drops or tear duct plugs." I found that interesting, as my opthalmologist put in temporary plugs and told me I should continue using Restasis. We decided not to do permanent plugs as I didn't notice much difference with the temps, which are made of collagen, and dissolve in around a week. Just FYI.
Posted @ Thursday, February 14, 2013 4:58 PM by Mary Beth
I had punctal plugs inserted today (lower). All day long I have felt increased dryness - like I can't wait to take my contacts out, only I haven't worn contacts in years since my eyes were too dry. I've used drops more today than ever. Does this get better with time?
Posted @ Wednesday, June 12, 2013 8:19 PM by Beth
Perhaps they fell out! I had trouble keeping mine in.
Posted @ Thursday, June 13, 2013 1:14 PM by sherry
I have had punctal plugs for about 2 years now. They were temporary once so I had to get them inserted approximately every 2-3 months. My ophthalmologist inserted permanent ones this year but one of my eye lids inflamed and every blink became painful. She took one of the plugs out and it has gotten better now. I am getting the upper plugs cauterized next month.
Posted @ Thursday, June 20, 2013 1:54 PM by Doreen Sibbald
I had punctal plugs and couldn't tolerate them. Then they used Laser Surgery to close my lower tear ducts and they opened up in 10 months. Now my doctor is suggesting cauterization. I always have a slight infection in my eyes. Would those who have had this procedure share about the recovery period. I am a slow healer and I am worried about infection.
Posted @ Wednesday, July 31, 2013 2:24 PM by Sandy Lee
Re Sally's post Sep 4, 2012-- 
my wife now uses Xylimelts for dry mouth. Can be used at night because you stick them to your inside cheek. Found at Rite-Aid Drug Store and
Posted @ Tuesday, August 13, 2013 10:22 AM by Marvin Reed
After Lasik my dry eye's were causing my now "perfect" vision to be extremely blurry. I finally had the bottom duct's closed. After almost a year, my vision was still blurry to the point it was difficult to even watch t.v. I went back and had the upper tear ducts plugged and it made a BIG difference in my dry eye. After being told for so long that your vision is perfect and all you see is blurry it starts to get to a person. The eye doctor explained I might get excessive tearing. At this point my vision is SO CLEAR. My advice if anyone had the same issue that I did to please try to get both upper and lower ducts plugged/ There was no reason I had to live that way when plugging two extra holes was the solution. If tearing is the worst of it, I will take it over not seeing blurry!!
Posted @ Thursday, November 07, 2013 10:00 PM by Kelly
I have had the bottom punctal plugs in both eyes for over one year. I requested having the top plugs inserted in both eyes 7 months ago. They have made a great improvement! Increased tearing at times is not a problem and I use less OTC eye drops.  
ML in Vermont
Posted @ Friday, November 08, 2013 5:40 AM by ML in Vermont
I have had lower plugs for over 20 yrs. with little moisture at all. About a month ago got upper and had moisture that even wet under my eyes - not tears on face but better. Today the moisture is gone and I am using drops all day again. I think they are still in and don't understand what happened. Will call Dr. on Monday. I was thrilled with the small amount of moisture and less drops.
Posted @ Saturday, January 11, 2014 1:56 PM by Sharon
I have had punctual plugs but they wouldn't stay in. I then had my ducts surgically closed. That was helpful. I tried Restasis at one time and had good results at first, but they later really damaged my eyes, probably due to the fact that I have an aspirin allergy. They are not recommended for people with an aspirin allergy, but my doctor thought I would be all right. WRONG! My current doctor recommended multi-focal one day soft contact lens. She said she had used them with other Sjogren's patients with good results. I am currently trying that and have had good results so far. She says my eye look much healthier.
Posted @ Saturday, January 11, 2014 2:46 PM by A. Duncan
I have been suffering with dry itchy, scratchy, gritty, runny, mucus producing dry eyes for 20 years now and it is currently unbarable. I just got puntal plugs and it has provided no releif. I don't know what to do. My quality of life has gone downhill due to this and the wrinkles under my eyes are horrible from rubbing and tugging. What else can I do? Putting in fake tears just makes them feel oily. They never feel normal.
Posted @ Wednesday, January 22, 2014 12:35 PM by Vicki
I don't know if it will help you, but my  
eye doctor put me in contact lenses. She 
had done this some other Sjogren's patients  
and it helped them. I have lenses that you 
throw away each night. Mine are bifocals. 
My eyes feel confortable all day while  
I have them in.
Posted @ Wednesday, January 22, 2014 10:53 PM by A. Duncan
I was told I can't wear contacts. I produce no tears and I produce a lot of mucus. :-(
Posted @ Thursday, January 23, 2014 8:20 AM by Vicki
My eye doctor told me I can't wear contacts. 
He said the contacts are like sponges that absorb moisture from the eyes. 
I would love to wear contacts again, if possible.
Posted @ Thursday, January 23, 2014 1:39 PM by Avis
Both my lower puncta closed at about the same time about 3 months ago, due to granuloma scar tissue from punctal plugs. 
Now one eye feels dry again, and when I looked, it seems that the puntum is reopening. Is that possible?
Posted @ Saturday, March 01, 2014 1:14 PM by Rita
Also, is it possible to re-insert punctal plugs when there is a small opening in the scar tissue in the puncta?
Posted @ Saturday, March 01, 2014 1:17 PM by Rita
I had plugs put in my lower lids this morning around 9 and am in so much pain. I don't think I will be able to tolerate them.
Posted @ Wednesday, April 23, 2014 6:09 PM by Genie Meacham
I had cataract surgery one year ago and had Chyrstalens put in because I had lasik 7 years ago and to accommodate the monovision the doctor used Chyrstalens. 
My distance eye is 20/20 but my reading eye is terrible. I work with numbers all day and now after 7 years have to wear glasses. I went to see the Dr. yesterday and he said I can try the plugs to see if my vision will be clearer for the reading eye. I told him if I use Systane eye drops in my eyes the reading eye is 20/20 for about 30 seconds and then it goes blurry again. So, the doctor thinks I have dry eye and the plugs will help that. I am scheduled for May 30 to have the plugs put in my lower lids and hope to see clearer for reading. 
do you think its a good idea to get the plugs? 
Posted @ Tuesday, May 13, 2014 3:01 PM by Kathy
I would like to know if someone has had all 4 punctal ducts closed at one time. and 
can tell me why I have trouble with my right eye ,because a specialist told me I have no hope for my right eye? the specialist opened the left lower duct and this eye is ok. but lots of Mucus in the right eye.
Posted @ Wednesday, June 11, 2014 5:55 PM by KATHIE WEBBER
I have dry eyes, but mainly the left one. I have a punctual plug in the lower lid. I use Restasis, and also an over the counter (Systane) drop as needed. However, someone told me to try large doses of fish oil, and three caps per day of Primrose oil. I have been doing so for over a month now, and have noticed a great difference.
Posted @ Tuesday, June 17, 2014 9:29 PM by Judith
I am on my 2nd set of plugs, I don't feel any improvement in my eyes, and have to apply drops & gel all day. How would I know if the plugs fall out?
Posted @ Friday, June 27, 2014 4:52 PM by Tina
Update: I had all 4 cauterized last year. I still had to use artificial tears but not as much as I did before the surgery. Last three months, I have felt my eyes drying out like it did before the cauterization. I am in the military and was stationed overseas so always had to see the military doctor on base. We moved back to the states 6 months ago and got a chance to see a civilian doctor. He informed me that my bottom cauterization has opened; that it looks like it was not done very well. He also mentioned that it was not a good idea to have all 4 cauterized at my age (31). He recommended that I use the one size fits all plugs available on the market now. He will insert it next month. I believe that each one of us will always be battling dry eyes; it's just a matter of how these different options can ease our suffering. I had to ask the military ophthalmologist for approval to be able to wear contacts during my wedding ceremony, she approved however I was ready to pull my eyes out during the reception.
Posted @ Saturday, June 28, 2014 1:12 PM by Doreen Sibbald
Re: Restasis for dry eye; have used these tid for 6 months with No Improvement in Tear Production. 
A VERY costly experiment!! Now I seem to be headed for Permanent Punctal Plugs. after reading these comments above, Im not very keen on this idea. dj
Posted @ Friday, August 01, 2014 9:44 AM by diana johnson
I have had improvement with 4 plugs. I have over tearing at times, but much less pain.
Posted @ Friday, August 01, 2014 7:05 PM by Myrna
I have severe dry eye and narrow angle glaucoma with iris plateau. After Iridioplasty, Iridotomy, I was on three kinds of drops a day, Restasis, GenTeal Gel Drops and Tobramycin, which didn't do much. Warm compresses twice a day help a lot. I tried and couldn't tolerate the Punctal Plugs, they tried the Collagen Plugs, lasted a day or two, had the bottom punctal plugs cauterized. There was 25% improvement in moisture. They put in collagen plugs again to see if the eyes would tear excessively, the left eye was fine, the right eye teared. We just cauterized the upper left eye, it feels better, but not sure if the tears are quality. If as some of you wrote you have too much mucus, do the warm compresses with wash cloth for 5 minutes straight twice a day, sounds like Blepheritis, and use sterile wipes twice a day. 
Posted @ Wednesday, August 20, 2014 4:44 PM by Robin Ames
In order to drive or see distance, I must wear contacts. I had RK surgery and am not a candidate for Lasix. Unable to wear soft contacts due to Post RK so I tried Hard Contacts. They would not stay sealed and would just pop out. Then my Doctor had me get Senergize Contacts. They are hard in the middle and soft on the outer edge. They work great for vision but my eyes, especially the right, are so dry. I am always putting drops of some sort in my eyes and didn't seem to help. Yesterday, she put a temporary plug in my right eye. Today I am so happy. Yes, I am still putting drops in, but not as often and I can't even tell I have contacts in other than I can see. I am so happy. I will be making an appointment to have permanent ones put in.
Posted @ Wednesday, October 08, 2014 2:54 PM by Charlotte
I tried everything including plugs.. Nothing helped.. I found a dry eye specialist and had amniotic membranes put in my eyes for like 4 days in each eye and the relief is amazing. I use restasis now to help to continue to improve my tear quality but those membranes are amazing. So happy to have found this doctor.,
Posted @ Wednesday, October 08, 2014 3:13 PM by Vicki Meholick
Vicki Meholick, I found your post interesting. Can you tell us more about these amniotic membranes.
Posted @ Sunday, October 19, 2014 12:19 AM by A Duncan
I am scheduled to have my punctal plugs put in the beginning of January 2015. I am looking forward to finally getting some relief. I tried Restasis and while it gave me a lot of relief it also gave me side effects so I'm unable to take it. I have sleep apnea will my CPAP push punctal plugs out?
Posted @ Sunday, November 16, 2014 10:37 PM by GreenFuzzer
Have cde and it got much worse after cataract surgery (r eye only right now). On Restasis for 6 weeks and serum tears (your own blood serum made into a drop) 6 times a day. A little improvement. Next treatment would be the amniotic tissue surgery, I also still use Systane in between the other. Warm compresses give some temporary relief. 
Posted @ Sunday, November 23, 2014 8:11 AM by Joan
Happy to find some info and hope I can find help.
Posted @ Monday, November 24, 2014 8:44 PM by Theresa
I had amniotic membranes put in my eyes for like 4 or 5 days a piece and the results were and are amazing. It's not 100 percent because this is not curable but I can finally go all day without thinking about my eyes. I use restasis now as well and continue to improve. I had tried everything prior to this
Posted @ Monday, November 24, 2014 8:54 PM by Vicki
I will have to google and look for info on the amniotic membrane treatment. I have been to several eye dr's, no one has mentioned anything like that.
Posted @ Monday, November 24, 2014 9:55 PM by Tina
I hope I will find a doctor that can do this procedure. Nothing is working for me. I am miserable. Could not tolerate plugs. So, so painful. I have lots of other health problems, take meds and this eye problem just makes it so hard. Thanks for the info. 
Posted @ Monday, November 24, 2014 10:05 PM by Genie Ramsey
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