What do systematic reviews say?

Summary of findings: punctal plugs vs artificial tears

Summary of findings: punctal plugs showed no clear difference in adverse events (punctate epithelial keratopathy) compared with artificial tears (low certainty).

• Punctal occlusion for dry eye syndrome 2017 · Cochrane Headline outcomes only
  RR 1.33 [0.57, 3.12]
  Studies not reported
  Low