Punctal Plugs for Dry Eye: How They Work and Who They Help
Punctal plugs in Korea, explained by a Seoul eye surgeon: how plugging the tear drain keeps your own tears on the eye, side effects, and who benefits.
Dr. Kim Sun-young, Director
Based on Dr. Kim's video
Korean audio · plays muted — tap the speaker for sound, CC for subtitles
The short answer
- A punctal plug blocks the small drain at the inner corner of the eyelid, so your own tears stay on the eye longer.
- It has been recognized as an effective dry eye treatment for decades and appears in international dry eye guidelines from step 2.
- The plug I use dissolves on its own; it is designed to work for at least six months, and in my experience often longer.
- The procedure takes about a minute, needs no anesthesia, and the main drawback is that a plug can fall out.
- I like it because natural tears contain anti-inflammatory, antibacterial and healing components that artificial tears lack.
Key moments
Tap a moment to jump the video there
I'm Dr. Kim Sun-young, medical director of Healing Eye Clinic in Gangnam, Seoul. As a cornea specialist — I was a clinical professor of cornea and cataract at Uijeongbu St. Mary's Hospital — I see dry eye every day, both in people who have never had surgery and in people recovering from LASIK or cataract surgery. Many of them have been using artificial tears for years and still feel gritty and tired.
For those patients, one treatment I like a great deal is often never mentioned: the punctal plug. A punctal plug doesn't add tears — it keeps your own tears on the eye longer, and your own tears are better medicine than any bottle.
What punctal occlusion is
At the inner corner of each eye, on the upper and lower lid, there is a tiny opening called the punctum. Tears drain through it into the nose. That's why your nose runs when you cry.
Punctal occlusion means placing a small plug in that opening. With the drain partly closed, tears stay on the eye longer, the tear film becomes richer, the cornea stays clean, and the eye feels smoother.
Why block the drain instead of making more tears? Because there is very little we can do to make the eye produce more tears, apart from good sleep and nutritional supplements. Slowing the drainage is the practical way to increase how much tear stays on the surface.
This isn't a new idea. Punctal occlusion was described as an effective dry eye treatment in a 1978 paper in Ophthalmology, one of the leading journals in the field.
What the plug is made of
The plug I use is made of polydioxanone, the same material as the dissolving stitches used in surgery. It breaks down naturally in the body, so it is harmless, and it is designed to work for at least six months. In my experience the effect often lasts longer than that.
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Side effects: mostly minor
What I like about punctal plugs is how few side effects there are.
- The plug falls out. This is the most common drawback. Blowing your nose hard or rubbing your eyes can push it out, and some people simply have a larger punctum. A plug that falls out completely causes no harm — the only loss is the plug.
- The plug is half out. Occasionally it sits partly out of the opening and rubs the eye, which can hurt. Check in a mirror; it needs to be pushed back in or removed by an eye doctor.
- Too many tears. Less often, the plug works so well that tears pool and spill over. If that happens, it usually settles within two to three weeks.
The risks of a punctal plug are mostly inconvenience, not damage to the eye. That's a very different trade-off from many dry eye medications.
Does it really work?
Yes. The Tear Film & Ocular Society (TFOS), the international society devoted to dry eye research, publishes treatment guidelines that go step by step. Punctal occlusion appears from step 2 — after basic measures like lid care and lubricating drops.
So why don't more clinics offer it? Honestly, because it is a nuisance for the clinic. The plugs are relatively costly, insertion takes skill and can be fiddly, and if a plug falls out a few days later, the patient is understandably unhappy. Clinics that believe in the treatment, though, use it a lot, because few dry eye treatments have such a clear effect.
How the plug is inserted, and what happens after
The plug is gently placed into the punctum. It takes about a minute, and no anesthesia is needed.
For roughly the first hour you may feel something at the inner corner when you blink. After that, most people stop noticing it. Afterwards:
- Don't blow your nose hard or rub your eyes, especially early on — this is the most common way plugs come out.
- If the corner suddenly hurts, check in a mirror whether the plug is sticking out. If it is, it needs to be pushed back in or taken out.
- If your eyes start to water a lot, give it two to three weeks; it usually settles.
Who a punctal plug suits
In my practice, plugs are most useful for people whose eyes simply don't make enough tears, and for whom habits alone aren't enough:
- People who have tried lid care, blinking exercises and artificial tears and still feel dry. I explain those first steps in dry eye treatment and habits.
- People with deep sleep problems, and women after menopause — groups whose tear production often drops and is hard to restore. For them I often recommend going straight to treatments that increase the tears on the eye, such as plugs or autologous serum drops.
- People with dry eye around vision correction or cataract surgery — see severe dry eye and vision correction and aftercare at home.
Plugs are one part of the Dry-Eye Clinic at Healing Eye, alongside meibomian-gland care and IPL; which combination you need depends on what is actually causing your dryness.
Dry eye treatment at Healing Eye
Dry eye care is planned after an exam, because the cost depends on what is causing the dryness — tear quantity, blocked oil glands or lid inflammation — and on which combination you need (punctal plugs, meibomian-gland care, IPL, autologous serum). Foreign patients pay the same price as Korean patients.
What to do next
If you've been living on artificial tears and nothing changes, it's worth finding out why your eyes are dry. A short exam tells me whether tear quantity, oil glands or the lids are the main problem — and whether a plug would help. At Healing Eye, the same doctor examines you, treats you and checks you afterwards, interpreters are on site, and foreign patients pay the same price as Korean patients. Send me your symptoms and I'll tell you what I'd look at first.
Procedures in this video
Questions patients ask
Do punctal plugs hurt?
No anesthesia is needed and insertion takes about a minute. For roughly the first hour you may feel something at the inner corner when you blink; after that most people don't notice it.
How long does a punctal plug last?
The plug I use is made of polydioxanone — the same material as dissolving surgical stitches — and is designed to work for at least six months before it dissolves. In my experience the effect often lasts longer.
What if the plug falls out?
Blowing your nose hard, rubbing your eyes, or a naturally large tear opening can push a plug out. A plug that falls out completely causes no harm. If it is half out and the corner hurts, look in a mirror and have an eye doctor push it back in or remove it.
Can punctal plugs cause watery eyes?
Occasionally the plug works so well that tears pool and spill over. If that happens, it usually settles on its own within two to three weeks.
About the doctor
Dr. Kim Sun-young, Director
Cornea · Glaucoma · Cataract
- MS, Catholic Univ. College of Medicine · Ophthalmology specialist, Catholic Medical Center
- Clinical Professor (Cornea & Cataract), Uijeongbu St. Mary's Hospital
- Best Resident Award, Seoul St. Mary's (2009) · Minister of Health & Welfare Award (2008)
- 108th Korean Ophthalmological Society Research Award · KDCA epidemiology citation
- Member — Korean Ophthalmological Society (KOS), KEEDS, KCLSS & ESCRS
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