Punctal Plugs

Punctal plugs are tiny medical devices that sit in the eye’s tear drains (the puncta) to slow or stop tears from leaving the eye. This helps keep natural tears and lubricating drops on the surface longer, easing dryness, burning, and irritation. 1

Doctors may recommend plugs when dry eye does not improve enough with artificial tears and lifestyle steps, or when tears drain too quickly. 2

Plugs are placed in the clinic in just a few minutes. Most people feel little more than brief pressure. There are temporary dissolvable types (often used as a test) and longer-lasting silicone styles. Your eye specialist will choose a size and shape that fits your tear drain.

How it works: Tears normally exit the eye through small openings in the eyelids called puncta, then travel through canals to the nose. By blocking the puncta with a small plug, tears stay on the eye longer so the surface stays moist and comfortable. 3

Options:

• Temporary dissolvable collagen plugs (often used as a short trial)
• Longer-lasting silicone plugs (removable if needed)
• Punctal plugs (sit at the opening)
• Intracanalicular plugs (sit deeper in the canal)

Your overall dry eye plan may also include eyelid care, anti-inflammatory drops, and environmental changes. 4

Good candidates: People with diagnosed dry eye who still have symptoms (stinging, gritty feeling, fluctuating vision) despite using artificial tears and healthy habits. Plugs help most when tears evaporate or drain too fast, and when the eye surface needs more time bathed in tears. 5

They can also be useful for people who rely on frequent drops or who have dry eye related to autoimmune disease, after discussion with their specialist. 6

Who may not be a fit:

• Main problem is eyelid oil gland (meibomian) dysfunction
• Active eye infection or significant mucus discharge
• History of frequent tearing (epiphora)
• Children (considered case by case)

Punctal plug insertion is an in-office procedure billed under CPT code 68761. Medicare and many insurers may cover it when medically necessary, but rules vary. 7

Typical patient costs:

• Clinic visit copay (evaluation/follow-up)
• Procedure copay or coinsurance (per punctum)
• The plug device itself (if billed separately)

Money-saving tips:

• Ask about a temporary dissolvable plug trial
• Check if both eyes can be treated the same day
• Use FSA/HSA funds if eligible

Good dry eye control can reduce indirect costs like missed work. 8

Benefits: Many studies show that punctal occlusion improves dryness symptoms and tear stability by keeping tears on the eye longer. 9 Expert reviews conclude plugs can help selected adults with dry eye, with results influenced by plug type and underlying disease. 10

Limitations & risks:

• Foreign-body sensation
• Extra tearing or plug loss
• Infection or canaliculitis (rare)
• Deep migration (older intracanalicular types)

Most problems are manageable and plugs can be removed if needed. 11 12

The procedure is quick with no downtime. Most return to normal activities immediately. Aware of the plug for a day or two is common. Call your clinic if redness, pain, or discharge increase. 13

Practical tips:

• If you use other drops, space them a few minutes apart
• Check with your doctor about wearing contact lenses
• Use a humidifier and take regular screen breaks

Recent analyses show punctal plugs improve tear film stability, tear production, symptoms, and ocular surface findings in moderate-to-severe dry eye. 15

Plugs are considered alongside options like anti-inflammatory drops, eyelid therapies, in-office heat devices, and scleral lenses. 16

Alternatives such as punctal cautery are also being studied for permanent closure needs.

If you have frequent dryness or fluctuating vision, start with a complete eye exam. Ask whether a dissolvable plug trial makes sense before committing to longer-lasting plugs. 17

Best specialists: Cornea/External Disease Ophthalmologists and optometrists with ocular surface expertise. Kerbside can connect you with the right specialist for educational consults (not a physician–patient relationship). 18