What each one is
Punctal plugs are tiny devices placed in the puncta, the small drainage openings at the inner corners of your upper and lower eyelids. Tears normally drain out through these openings. A plug partly or fully blocks the drain so the tears you produce stay on the eye longer.[1] Plugs come in different materials and designs. Some are biodegradable and dissolve; others, often silicone, are meant to stay until removed.[5]
A scleral lens is a large rigid contact lens that rests on the white of the eye and arches over the cornea. It’s filled with preservative-free saline before it goes in, so the cornea sits under a pool of fluid all day. It doesn’t rely on your own tear production, and it shields the cornea from the eyelids rubbing over it.
Side by side
| Punctal plugs[1][3] | Scleral lens[6] | |
|---|---|---|
| How it helps | Keeps your own tears on the eye longer | Holds a reservoir of saline over the cornea |
| Depends on your tears? | Yes. It conserves what you make | No. It brings its own fluid |
| Procedure | A brief procedure at the eye doctor’s office | Custom fitting, usually several visits |
| Daily effort | None | Insertion, removal, cleaning, and filling every day |
| Vision | No direct effect | Can improve vision when the surface is damaged or irregular |
| Reversible | Yes. Silicone plugs can be removed. Some dissolve | Yes. Stop wearing it |
| Common problems | Plugs falling out, watery eyes, irritation, occasional infection of the tear drain | Handling difficulty, fogging, infection risk shared with all contact lenses |
| Usually used for | Dry eye with low tear production, often earlier in treatment | Moderate to severe ocular surface disease after other treatments |
What the research on punctal plugs shows
Plugs are widely used, but the reviews disagree on how well they work.
- The Cochrane review (2017) found 18 trials with 711 participants and 1,249 eyes. Most were poorly reported. When plugs were compared with no plugs, there was little or no improvement in symptoms, and only small, possibly unimportant improvements in surface staining and tear film stability. The reviewers concluded the evidence was inconclusive.[1]
- A 2025 meta-analysis that also included cohort studies pooled 17 studies with 1,658 patients and found significant improvements in tear stability, tear production, symptom scores and surface staining. On average, 86% of plugs stayed in place.[2]
The difference is partly about which studies each review counted. Either way, plugs are treated as a reasonable step for many people with dry eye, not a sure fix.
Side effects and plugs falling out
- Watery eyes and irritation. The Cochrane review reported that adverse events occurred reasonably often with plugs, including watery eyes, itching, tender or swollen lids with mucus discharge, and plugs moving out of place. Less commonly, the tear drainage sac becomes inflamed or infected.[1]
- Plugs often fall out. In a study of 163 people with Sjögren’s syndrome who had silicone plugs, 58% of plugs were lost on their own and 14% were removed by the doctor. Half of the plugs had stayed in place for about seven months or less. The most common reason for removal was tears overflowing (5.6%).[3]
- Removed plugs can carry bacteria. In 64 eyes that had plugs removed because of discomfort, the most common reasons were the plug sticking out, with or without a small inflamed bump of tissue, and 42.2% of removed plugs grew bacteria in the lab.[4]
- Plugs can be retained without anyone knowing. A case report describes an infection of the tear drain in which surgeons found five old silicone plugs that had been assumed to have fallen out.[5]
What the research on scleral lenses shows
Scleral lens studies in dry eye and ocular surface disease are mostly case series from specialty clinics.
- In a US tertiary center, people evaluated for scleral lenses for ocular surface disease had already tried an average of 3.2 other treatments. Of 115 who completed fitting, all but 2 reached their treatment goals.[6]
- In 41 eyes with moderate to severe dry eye, a year of scleral lens wear improved vision, symptoms, and quality of life.[8]
- In a study of 49 people with severe ocular surface disease, many had preparatory procedures, such as punctal occlusion, before their scleral lens fitting.[7]
That last point matters: in practice, plugs and scleral lenses often aren’t competing. Plugs are frequently tried first, and a scleral lens is added if the cornea still isn’t protected.
Questions to ask your eye doctor
- Is low tear production the main problem for me, or is it something else, like inflammation or the oil glands?
- Would plugs help, and would you start with temporary ones?
- If I already have plugs, are they still in place?
- At what point would you consider a scleral lens?
- Could plugs and a scleral lens work together for me?
See also our pages on severe dry eye, Sjögren’s syndrome, and scleral lenses vs autologous serum drops.
Common questions
Do punctal plugs hurt?
Plugs are usually placed in the office. Some people notice them, and in studies, discomfort, itching or lid swelling were among the reasons plugs were removed. If a plug becomes uncomfortable or the area gets red, swollen or sticky, see your eye doctor.
Can I wear scleral lenses if I have punctal plugs?
Generally, yes. Plugs sit in the tear drains at the inner corners of the eyelids, away from where a scleral lens rests. Many people with severe dry eye who wear scleral lenses have had punctal occlusion. Your fitter will check the whole eye surface either way.
My plug fell out. Is that a problem?
Plugs falling out on their own is common. In one study of people with Sjögren's, more than half of plugs were lost spontaneously. Tell your eye doctor, who can decide whether to replace it, try a different size or type, or check that it hasn't moved deeper into the drain.
Are plugs permanent?
Some dissolve on their own over time and others are made to stay until removed. Your eye doctor will choose the type.