Punctal plugs for dry eye: my honest experience, 8 years on

I had my punctal plugs fitted at the Dry Eye Centre in London by Dr Tam, at the same time I was going to him for my IPL. They're one of the best things I've ever done for my eyes, but before I get into that, let me clear up the thing almost everyone (me included, once) gets wrong.

What punctal plugs actually do (the bit everyone misunderstands)

People think your tear ducts produce your tears. They don't. Your lacrimal glands produce your tears. Your tear ducts are the little holes your tears drain away through. It's the tiny hole you can see in the inner corner of your eye, along your lash line. That's where you lose your tears.

Punctal plugs are exactly what they sound like: tiny silicone plugs that sit in those drainage holes and block them. The idea is simple: if you're not draining your tears away so fast, the few tears your eyes do make stay on the surface for longer. And my eyes make very few; when I did my Schirmer's test, my tear production was really low. So keeping every tear I've got working for as long as possible makes a real difference.

(And yes, I can see them if I look closely in the mirror. I still like to check they're there.)

I tried the dissolvable ones first

I started with dissolvable plugs, just the lower two that time, as a sort of trial. I'll be honest: I didn't notice much difference. I was doing a lot of my own research at this point, and I kept seeing other people say the same thing: no luck with the dissolvable ones, but the silicone ones helped. So I went back and said, let's just try the silicone.

The cost, and why I went private

You can get punctal plugs on the NHS. But by this stage I'd lost a bit of faith, and there were the waiting times too. And, God bless the NHS, but I was in a lot of pain and struggling, so I went private.

Privately it was £250 per plug: that's £250 per tear duct. You have four ducts in total (an upper and a lower in each eye). I started with just the bottom two, so that was £500. I did get some improvement... but I still wasn't where I wanted to be, and, again from all my reading, a lot of people said two plugs alone didn't do much for them either.

So next time I said, let's plug the top two as well. Another £500. And that's when everything changed.

The train home I'll never forget

I was on the train back from London to my house, and it suddenly hit me: "Oh my God, I haven't thought about my eyes for the last five minutes."

If you live with dry eye, you'll understand exactly what that means. At its worst, it's all-consuming: your eyes are all you can think about, every second of every day. And here I was, having just... not thought about them. Then I realised I had tears in my eyes for the first time in what felt like forever. It's so bizarre: you go your whole life never giving your eyes a second thought, then dry eye arrives and they're all you can think about, and suddenly, for a moment, they weren't. It honestly felt like a miracle.

I'll be honest, though: it wasn't a permanent miracle. That incredible relief didn't last forever, and dry eye is still very much part of my life. But I do genuinely believe the plugs help me, and they're another important tool in my belt.

The procedure itself (genuinely painless)

I know this is the part people are nervous about, so here's exactly what happens. They put numbing drops in first. Then they use a little instrument, almost like a tiny metal toothpick, to gently open up your tear duct a fraction, just to widen it. Then the plug simply pops in. No pain whatsoever.

I was curious, so I actually watched him do it on camera, though I definitely wouldn't recommend that if you're at all squeamish! He also tried a couple of different sizes first, and honestly I think that's why mine have lasted so long: he took the time to find the size that properly fitted my ducts. You can get bigger and smaller ones, and getting the fit right is everything.

What they feel like, and how long they've lasted

For the first day or two I could feel them if I looked to the corner of my eye. After that? Nothing. I genuinely never notice them now. I go swimming with them, I never think about them. They're just there, and I'm glad they are.

Here's the honest longevity picture. My top two fell out after about six months. I had them fitted around summer 2018, and by the very end of that year both top ones were gone. That actually makes sense: gravity's working against the top ones. But my bottom two are still in there, eight years later. Even at £250 each, eight years in and still going, I really can't complain. I think a big part of that is simply having a very good fitter.

I've never had the top two replaced, though I might one day. There's also a more permanent route I may consider further down the line: instead of plugs, you can have your tear ducts closed for good, either by cauterising them (sealing them with heat) or stitching them shut. For now, though, I'm very happy with my bottom plugs, so I'm in no rush.

What about the watery overflow?

You may have read that some people get too much overflow with plugs (watery, streaming eyes) and have to have them taken straight back out. It can happen, because you're keeping more tears on the surface. For me it was never really an issue; I get the occasional overflow, but nothing bothersome. I think that's simply because my eyes produce so few tears in the first place. With just my bottom two in now, I get no real overflow at all.

The honest flip side

I want to give you the rounded picture, because dry eye is a minefield of differing opinions: you'll get different advice from different specialists, and a lot of it comes down to trial and error and seeing what works for you.

Some optometrists don't recommend plugs, and here's their main argument: when you have dry eye, your tears are full of inflammation. By plugging your drainage, you're keeping those inflammatory tears sitting on your eyes for longer, potentially trapping the inflammation in. It's a fair point, and the research does say plugs are best used after your inflammation is under control, not as a first move (here's a good overview if you want to read into it). That just hasn't been my experience; for me they've been genuinely helpful. But everyone is so different, and that's the whole frustrating, personal nature of this condition.

My verdict

Punctal plugs are one of the best things I've done for my eyes. Eight years on, with my bottom two still quietly doing their job, I'd recommend them, with the honest caveat that they suit the tear-deficient type of dry eye (like mine), they're best done once inflammation's under control, and getting a skilled fitter really matters. If that sounds like you, they're well worth asking a specialist about.