American Academy of Ophthalmology

View all recommendations from this society

Released February 21, 2013

Don’t place punctal plugs for mild dry eye before trying other medical treatments.

Medical treatments to address dry eye are available, such as artificial tears, lubrication and hot, moist compresses. These medical methods, as well as ways to modify the environment, should be tried first to improve dry eye and normalize the tear film before using punctal plugs. If the patient’s tear film and eyelids have been treated and dry eye symptoms persist, then punctal plugs can be added.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about items on this list or their individual situation should consult their ophthalmologist.

How The List Was Created

The American Academy of Ophthalmology’s Medical Director of Health Policy and Health Policy Committee led the Academy’s list development process. Members of the Health Policy Committee initially identified potential recommendations based on relevance, appropriateness and potential for improvement and efficiency. Through society notifications and newsletter notices, other ophthalmic organizations and subspecialty societies and members were invited to offer feedback and recommend ideas to be included in the final recommendations. Health Policy Committee members and the Medical Director of Health Policy reviewed the ideas and supporting evidence, and ranked them in order of potential impact. The top five recommendations were presented to the Academy’s Board of Trustees for approval.

The American Academy of Ophthalmology’s disclosure and conflict of interest policy can be found at


American Academy of Ophthalmology Retina Panel. Preferred Practice Pattern® Guidelines. Conjunctivitis – Limited revision [Internet]. San Francisco, CA: American Academy of Ophthalmology; 2011 [cited 2012 Sep 28]. Available from:

Ervin AM, Wojciechowski R, Schein O. Punctal occlusion for dry eye syndrome. Cochrane Database Syst Rev. 2010, Issue 9. Art. No.: CD006775. DOI: 10.1002/14651858. CD006775.pub2.

Altan-Yaycioglu R, Gencoglu EA, Akova YA, Dursun D, Cengiz F, Akman A. Silicone versus collagen plugs for treating dry eye: Results of a prospective randomized trial including lacrimal scintigraphy. Am J Ophthalmol [Internet]. 2005 Jul;140(1):88–93.

Nava-Castaneda A, Tovilla-Canales JL, Rodriguez L, Tovilla Y Pomar JL, Jones CE. Effects of lacrimal occlusion with collagen and silicone plugs on patients with conjunctivitis associated with dry eye. Cornea [Internet]. 2003 Jan;22(1):10-4.

Tai MC, Cosar CB, Cohen EJ, Rapuano CJ, Laibson PR. The clinical efficacy of silicone punctal plug therapy. Cornea [Internet]. 2002 Mar;21(3):135-9.

Horwath-Winter J, Thaci A, Gruber A, Boldin I. Long-term retention rates and complications of silicone punctal plugs in dry eye. Am J Ophthalmol [Internet]. 2007 Sep;144(3):441-4.

Mazow ML, McCall T, Prager TC. Lodged intracanalicular plugs as a cause of lacrimal obstruction. Ophthal Plast Reconstr Surg [Internet]. 2007 Mar-Apr;23(2):138-42.

SmartPlug Study Group. Management of complications after insertion of the SmartPlug punctal plug: a study of 28 patients. Ophthalmology [Internet]. 2006 Oct;113(10):1859.

Marcet MM, Shtein RM, Bradley EA, Deng SX, Meyer DR, Bilyk JR, Yen MT, Lee WB, Mawn LA. Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome: A Report by the American Academy of Ophthalmology. Ophthalmology. 2015 May 30. pii: S0161-6420(15)00417-0.