These are small silicone devices inserted into the puncta drainage holes in the eye to allow the tears to last longer and help correct dry eye. Punctal plugs are relatively easy to insert and this can be done right in the exam chair. By slowing down the tear drainage, the ocular surface is better moistened. The plugs are microscopic and can’t be easily seen or felt. Unfortunately, the plugs have a tendency to fall out … this can occur weeks or months after insertion, though I’ve seen plugs last as long as 10 years in good position. Occasionally, the plugs themselves cause mild irritation and excessive tearing – in these cases we simply remove the plugs using tweezers. More permanent closure of the puncta can be done, but I prefer to use the silicone plugs because they can always be removed later if needed.