The Jackson Davenport Vision Center Team
If your eyes burn by mid-afternoon, water at stoplights, or feel like there's sand in them by the time you get home, you have probably already tried the drugstore aisle. For a lot of people, that works. For a lot of other people it stops working — and when it does, that is information worth acting on rather than a dead end. Inadequate relief from artificial tears can have several explanations, and sorting out which one applies to you is what an eye exam is for.
Comparing prescription eye drops vs. punctal plugs for dry eye starts with the cause. Prescription drops work by different mechanisms — calming inflammation, slowing evaporation, or stimulating tear production; punctal plugs slow tear drainage so the tears you already make stay on the eye longer. They solve different problems, and can be used together. Jackson Davenport Vision Center evaluates and manages dry eye in Summerville.
Here is the whole ladder — and why the current thinking is that it isn't really a ladder at all.
Why "Just Use Drops" Isn't the Whole Answer: Too Few Tears vs. Poor-Quality Tears
Start with what a tear actually is, because everything downstream depends on it.
The American Optometric Association describes tears as three layers — oil, water, and mucus — each doing a different job. As the AOA's dry eye page puts it, "a smooth oil layer helps prevent evaporation of the water layer, while the mucin layer spreads the tears evenly over the surface of the eye." The oil comes from small glands along the edge of your eyelids. The water comes from the tear glands. Take away either one and the film stops working, even if the other is fine.
That gives you the two halves of dry eye that the AOA names directly: people with dry eyes "either do not produce enough tears or their tears are of a poor quality."
- Not enough tears — a volume problem. Tear production tends to decrease with age, with certain medical conditions, and as a side effect of some medications.
- Poor-quality tears — an evaporation problem. The tears are there, but without a healthy oil layer they evaporate off the surface too fast. This is the one most people are surprised to learn they have, because their eyes water.
Why watery eyes are a classic dry eye symptom
It sounds backwards, and it is a common source of confusion — enough that people talk themselves out of getting seen over it. When the surface of the eye is irritated and drying out, the eye responds with a flood of reflex tears — thin, watery ones that spill over the lid instead of coating the eye. The AOA lists "excess watering" among dry eye symptoms alongside irritated, gritty, scratchy or burning eyes and blurred vision. Watering is not proof your eyes are wet enough. It is often the opposite signal.
What over-the-counter artificial tears do — and where they stop
Over-the-counter artificial tears are a legitimate first step, not a consolation prize. They add moisture, they reduce friction between the lid and the cornea, and for mild dry eye they are often enough. The National Eye Institute calls artificial tears "the most common treatment for mild dry eye," and there are gels and ointments for people who need something thicker overnight.
What they do not do is change why the eyes are dry. Lubricating the surface can dilute irritants and reduce friction, but it does not treat the underlying inflammatory process, and it does not open blocked oil glands. The AOA states the consequence plainly: "People with dry eyes that don't respond to artificial tears alone will need to take additional steps to treat their dry eyes."
Two practical notes from the same AOA guidance. First, preservative-free artificial tear solutions "are recommended because they contain fewer additives, which can further irritate the eyes" — worth knowing if you are reaching for the bottle many times a day. Second, this is a product category the FDA has issued safety warnings about: in February 2023 the agency warned consumers not to purchase or use certain artificial tears over potential bacterial contamination. Buy from a reputable pharmacy, and bring the bottle you are actually using to your appointment. Your eye doctor can tell a lot from it.
What Changed in 2025: Dry Eye Care Moved From a Ladder to a Target
For years, dry eye care was taught as a staircase. Step one, artificial tears. Then, if symptoms persisted, step two — prescription drops or plugs. Then step three. Treatment was commonly organized in escalating stages, each one generally tried before the next was offered.
That changed with the TFOS DEWS III reports, published in 2025 by the Tear Film & Ocular Surface Society (tearfilm.org) in the American Journal of Ophthalmology. Two things in that update matter to you as a patient.
Dry eye is now defined as a symptomatic disease. The current definition reads: "Dry eye is a multifactorial, symptomatic disease characterized by a loss of homeostasis of the tear film and/or ocular surface, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities are etiological factors." The word symptomatic is new. What you report — the burning, the grittiness, the fluctuating vision — is now a diagnostic requirement rather than a footnote to the test results.
And the staircase became a set of targets. Rather than a fixed step ladder, the current framework organizes management around what is actually driving the disease — the tear film, the eyelids, or the ocular surface — which means a doctor can address two drivers at once instead of making you work through a queue.
The practical translation: if artificial tears have not helped, that is not a verdict on you and it is not the end of the options. Inadequate relief can have several explanations, and sorting out which one applies to you — which driver is actually in play — is what an eye examination is for.
The Prescription Tier: What Anti-Inflammatory and Tear-Stimulating Drops Do — and What They Don't
When lubrication alone is not enough, an eye doctor may discuss prescription therapy. These are FDA-approved prescription medications, each approved for a specific indication, and they work by different mechanisms — which is exactly why the diagnosis has to come first.
None of them cure dry eye. Dry eye is frequently a chronic condition; the goal is management, and several of these take weeks to months of consistent use before the benefit shows up. That expectation is worth setting now, because a delayed onset can affect whether people stay on a medication long enough to find out if it helps.
Here is what the FDA-approved labels actually say:
- Cyclosporine ophthalmic emulsion (Restasis) — FDA-approved indication (from the label): To increase tear production in patients whose tear production is presumed suppressed due to ocular inflammation associated with keratoconjunctivitis sicca. What it targets: Immune-driven inflammation limiting tear production.
- Lifitegrast ophthalmic solution 5% (Xiidra) — FDA-approved indication (from the label): "A lymphocyte function-associated antigen-1 (LFA-1) antagonist indicated for the treatment of the signs and symptoms of dry eye disease (DED)". What it targets: Inflammatory cell adhesion on the ocular surface.
- Loteprednol etabonate 0.25% (Eysuvis) — FDA-approved indication (from the label): "A corticosteroid indicated for the short-term (up to two weeks) treatment of the signs and symptoms of dry eye disease". What it targets: Short-term rescue during a flare.
- Varenicline nasal spray (Tyrvaya) — FDA-approved indication (from the label): "A cholinergic agonist indicated for the treatment of the signs and symptoms of dry eye disease". What it targets: Nerve pathway that switches on your own basal tears — a nasal spray, not a drop.
- Perfluorohexyloctane (Miebo) — FDA-approved indication (from the label): "A semifluorinated alkane indicated for treatment of the signs and symptoms of dry eye disease". What it targets: Evaporation — it forms a layer that slows tears drying off the surface.
- Acoltremon 0.003% (Tryptyr) — FDA-approved indication (from the label): "A TRPM8 thermoreceptor agonist indicated for the treatment of the signs and symptoms of dry eye disease". What it targets: Corneal nerve receptors that trigger natural tear production.
Two of those are genuinely new. Perfluorohexyloctane was approved in 2023 and is aimed squarely at the evaporation side rather than the volume side. Acoltremon, approved in May 2025, is a first-in-class nerve-receptor drop. Neither existed when a lot of the dry eye advice floating around online was written.
The one that is not a dry eye drug
You will see lotilaner ophthalmic solution 0.25% (Xdemvy) listed in dry eye roundups constantly. Its label is unambiguous: it "is an ectoparasiticide (anti-parasitic) indicated for the treatment of Demodex blepharitis." It treats mites in the eyelash follicles. Demodex blepharitis can absolutely sit underneath dry-eye-type symptoms, which is why it comes up — but the drug is not a dry eye medication, and whether it is relevant to you depends on whether an eye doctor actually finds the mites at the lid margin.
What this tier costs you in patience, not just money
Prescription dry eye drops are dispensed through a pharmacy, and what you pay depends on your specific plan — which of your benefits applies, whether the medication is on that plan's formulary, and whether the plan asks for documentation before it will cover one. Those rules vary from payer to payer and from medication to medication, so ask the office to check your benefits at the visit rather than finding out at the pharmacy counter — it is the difference between leaving with a plan and leaving with a surprise.
Punctal Plugs: Keeping the Tears You Already Make, Who They Suit, and What to Expect
Your tears drain. They leave the eye through tiny openings in the inner corners of your eyelids called the puncta, into ducts that empty into the back of your nose. If your tear volume is low, one sensible move is not to add more tears but to slow the outflow.
That is what punctal plugs do. As the National Eye Institute describes them: "If tears are draining too quickly from your eyes, your doctor may suggest putting special plugs (called punctal plugs) in your tear ducts... These plugs can help keep your tears in your eyes." The AOA files the same idea under conserving tears — "keeping natural tears in the eyes longer can reduce the symptoms of dry eyes."
What the procedure is actually like
Insertion is an in-office procedure, not surgery. The doctor sizes the punctum and places the plug; it typically takes a few minutes. Plugs come in two broad categories:
- Temporary, dissolvable plugs made of collagen, which break down on their own over a short period. These are often used as a trial — a way to find out whether slowing the drainage helps you, and whether it tips you into overflow tearing, before committing to anything longer-lasting.
- Longer-lasting plugs made of silicone or a gel-like material. The AOA notes these "can be removed if needed," which is the reassuring part: this is a reversible intervention.
Plugs can also be placed at slightly different depths — some sit visibly at the opening, others are placed deeper in the duct and are not visible at all. Which one suits you is a fitting decision, not a preference you need to arrive with.
The honest downsides
Plugs are not a set-and-forget fix, and a good practice will tell you so up front:
- Overflow tearing. If you end up producing more tears than the newly restricted drainage can handle, your eyes water. That is the specific thing a dissolvable trial plug is designed to find out safely.
- They can fall out. Extrusion is common, often from ordinary eye rubbing. It is not a failure; it sometimes just means a resize.
- Irritation or a foreign-body sensation, and less commonly inflammation or infection of the tear duct, which is a reason to call your eye doctor rather than wait it out.
Why inflammation gets assessed first
There is a reason plugs are usually not the first thing offered. If the ocular surface is significantly inflamed, closing the drain can keep those inflammatory tears sitting against the cornea instead of washing away. So your eye doctor will assess ocular-surface inflammation when deciding whether and when punctal plugs are appropriate for you — and, consistent with the driver-based thinking above, that decision is an individualized one rather than a fixed order of operations.
So if you have read that plugs are the quick fix and your eye doctor wants to calm things down first, that is a considered clinical judgment about your eyes, not a delay tactic.
Prescription Eye Drops vs. Punctal Plugs for Dry Eye: Which Problem Each One Solves
This is the comparison most people are actually searching for, and the short version is that they are not competitors. They sit on different parts of the problem.
- What it is — Prescription eye drops: An FDA-approved medication, dispensed by a pharmacy. Punctal plugs: A small medical device placed in the tear drainage opening, in office.
- What it changes — Prescription eye drops: The biology — inflammation, evaporation, or the nerve signal that produces tears. Punctal plugs: The plumbing — how fast the tears you make drain away.
- Best suited to — Prescription eye drops: Inflammation-driven dry eye, evaporation-driven dry eye, or low tear production, depending on which drug and which driver. Punctal plugs: Aqueous-deficient (low-volume) dry eye, once inflammation is controlled.
- How fast you feel it — Prescription eye drops: Varies by mechanism; the immunomodulators often need weeks to months of consistent use. Punctal plugs: Effect is mechanical and can be noticed quickly, though it is not guaranteed to help.
- Can it be discontinued or changed? — Prescription eye drops: Yes, under your prescriber's direction — never on your own. Punctal plugs: Yes — dissolvable plugs resorb; longer-lasting plugs can be removed.
- Main drawback — Prescription eye drops: Time to effect, tolerability, and what your plan covers. Punctal plugs: Overflow tearing, extrusion, and it treats no inflammation at all.
- Regulatory status — Prescription eye drops: FDA-approved drugs (each for a specific indication). Punctal plugs: FDA-cleared devices, cleared through the 510(k) pathway.
That last row is worth pausing on, because marketing blurs it constantly. A prescription drug carries FDA approval for a specific indication. Devices reach the market by more than one route — some through premarket approval, some through the De Novo pathway, and many through 510(k) clearance, where, in the FDA's own description, the manufacturer demonstrates the device is "substantially equivalent to a legally marketed predicate device that does not require premarket approval." Punctal plugs go the 510(k) route: the FDA's device classification record lists "Plug, Punctum" as a 510(k) device. So "FDA-cleared" and "FDA-approved" are not interchangeable, and a page that advertises a cleared device as FDA-approved is telling you something about its precision.
And in practice, the two tiers are frequently used together: quiet the inflammation with a drop, then conserve what the eye produces with a plug. Which order, and whether either belongs in your plan at all, comes out of the exam.
Caring for the Glands: Lid Hygiene, Warm Compresses, In-Office Options, and When to Escalate
Because so much dry eye traces back to the oil glands in the eyelids, treating the lids is often where the real progress happens — and the AOA lists "treating the contributing eyelid or ocular surface inflammation" as one of the four primary approaches to managing dry eye, alongside adding tears, conserving tears, and increasing tear production.
At home, done properly
The at-home version is unglamorous and it is also the part most people do halfway.
- Warm compresses. Warmth may help soften thickened oil so it can move, and holding that warmth long enough is the part most people cut short. Ask your eye doctor what to use, how warm, how long, and how often for your situation rather than guessing — the right compress and the right routine are individualized instructions, not a one-size-fits-all recipe.
- Gentle lid massage after the heat, to help the softened oil actually clear the glands.
- Lid hygiene — a dedicated lid cleanser or foam to keep debris and bacterial film off the lash line. The AOA names "eyelid cleaners" among the tools a doctor of optometry may recommend for lid and surface inflammation.
- Blink on purpose. More on this in a moment, and it is free.
In-office options your eye doctor may discuss
When at-home care is not enough, there are in-office procedures that apply controlled heat or light to the eyelids to address gland dysfunction — thermal expression systems and intense pulsed light among them. These are regulated as medical devices, and whether any of them is covered — and what it would cost you — depends on your payer, your plan, and your diagnosis, so ask the office to verify benefits before you schedule one.
Two honest caveats. First, these are options an eye doctor may discuss or refer you for; not every practice performs every procedure, so ask specifically what is available where you are being seen. Second, be skeptical of any device marketed to you as a cure for dry eye. Whichever route a device took to market, its authorization is tied to a specific stated use — not to "dry eye" as a blanket claim — so the question worth asking is what this particular device is authorized to do, and for whom.
The lifestyle side is not filler
Dry eye has many contributors — age, hormonal changes, medications, autoimmune and systemic conditions, contact lens wear, eyelid disease, and environment among them. A couple of them are things you can act on directly, starting today.
Screens. The American Academy of Ophthalmology puts the numbers plainly: humans normally blink about 15 times a minute, but studies show we blink only about 5 to 7 times a minute while using computers and other digital screens. Blinking is how the eye spreads moisture across its surface, so a drop of that size leaves the surface drying out between blinks. The AAO's recommendation is the 20-20-20 rule: every 20 minutes, shift your eyes to look at an object at least 20 feet away for at least 20 seconds. Making a conscious effort to blink more while you work helps too, and costs nothing.
And it is not the blue light. The AAO is direct about this: there is no scientific evidence that blue light from digital devices causes damage to your eye, and the Academy does not recommend blue light-blocking eyewear for computer use. What people are feeling is digital eye strain. Reduced blinking is a major contributor to the dryness part of it, though strain also involves the sustained focusing effort of long close work — which is why breaks help as much as blinking does. Either way, a filter that targets neither is not the fix.
Environment and medications. The AOA lists exposure to smoke, wind, and dry climates as tear-evaporation drivers, along with common medications — antihistamines, decongestants, blood pressure medications, and antidepressants — that can reduce tear production. Long-term contact lens wear is a factor too, as is prior refractive surgery such as LASIK. This is exactly why the medication list you bring to your exam is not a formality. To be clear about the medication side: that is a conversation between your eye doctor and the clinician who prescribed it — never a reason to stop something on your own.
What a Dry Eye Evaluation Involves — and the Signs That Mean Call Right Away
A dry eye workup is more than the part where you read the letters.
According to the AOA, testing "with emphasis on the evaluation of the quantity and quality of tears" typically includes your patient history — symptoms, general health, medications, and environmental factors; an external examination of the eye including lid structure and blink dynamics; evaluation of the eyelids and cornea using bright light and magnification; and measurement of the quantity and quality of tears, where special dyes may be used to observe tear flow and highlight changes to the eye's surface. Some practices add point-of-care tests that measure tear chemistry or inflammatory markers directly.
The reason for all of it is the theme of this article: the treatment follows the driver. You cannot pick between a drop and a plug without knowing which problem you have.
How often should adults be examined?
Cite the body, because the two major organizations answer this differently and both are legitimate.
- The American Optometric Association, in the second edition of its Comprehensive Adult Eye and Vision Examination guideline released in March 2023, recommends annual comprehensive eye exams for persons 18 through 64 years of age, to optimize visual function, evaluate eye changes, and support early detection of sight-threatening eye and systemic conditions.
- The American Academy of Ophthalmology, framing its schedule around asymptomatic medical risk, recommends baseline intervals of every 5 to 10 years under 40; every 2 to 4 years from 40 to 54; every 1 to 3 years from 55 to 64; and every 1 to 2 years at 65 and older.
Either way, once dry eye is diagnosed you are no longer in the asymptomatic column, and follow-up timing is set by your eye doctor.
The symptoms that mean don't wait
Ordinary dry eye discomfort warrants a scheduled visit. A separate, shorter list warrants prompt or emergency care. Contact an eye doctor right away — or seek emergency care — for any of the following:
- Sudden vision loss or a sudden change in vision
- Sudden severe eye pain with redness and nausea or vomiting — a possible emergency
- A sudden shower of new floaters or flashes of light, or a curtain or shadow across part of your vision
- Sudden double vision, or sudden distortion of central vision
- Sudden, extreme light sensitivity — dry eye itself can leave you glare-sensitive day to day; what belongs on this list is severe light sensitivity that comes on abruptly
- An eye injury or chemical splash — flush and get emergency care immediately
Separately, symptoms that are persistent rather than sudden — eyes that stay red, blurry, or watery, or that become painful or light-sensitive over time — are a reason to book an appointment rather than wait them out. The AAO gives that same advice on its digital-eye-strain guidance. Timing follows the symptom: sudden and severe means now; persistent means soon.
Dry Eye Treatment: Common Questions
Can dry eye be cured? It is more accurate to say it is managed. Dry eye is frequently a chronic condition. The AOA's framing is that a doctor of optometry can prescribe treatment "to keep your eyes healthy and comfortable and to prevent your vision from being affected." That is a real goal and it is not the same as a cure, and any product promising to cure dry eye is overselling.
Should I compare prescription eye drops vs. punctal plugs and pick one? They are not really an either/or. Prescription drops change the biology — inflammation, evaporation, or the tear-production signal. Plugs change the drainage so the tears you make stay put. Which one, or both, depends on whether your problem is tear volume, tear quality, inflammation, or some combination, and that comes out of an exam rather than a search.
How long do prescription dry eye drops take to work? It varies a great deal by medication and by person. The immunomodulator drops in particular are known for needing weeks to months of consistent use before the benefit is apparent, which is why people who expect same-week relief often stop too early. Ask your eye doctor what timeline to expect for the specific medication you are prescribed — and do not start, stop, or change a prescription on your own.
Are punctal plugs permanent? No. Collagen plugs dissolve on their own within a short period and are often used as a trial. Silicone or gel plugs are longer-lasting but removable. It is also fairly common for a plug to fall out on its own.
My eyes water constantly. Can that really be dry eye? Yes, and it is one of the most common points of confusion. Excess watering appears on the AOA's own list of dry eye symptoms. Irritation from a poor tear film can trigger a flood of reflex tears that spill over rather than coating the eye. Watering does not rule dry eye out — it is a reason to have the tear film evaluated.
Do blue light glasses help dry eye from screens? The AAO says there is no scientific evidence blue light from digital devices damages the eye, and it does not recommend blue light-blocking eyewear for computer use. The mechanism behind screen-related dryness is the drop in blink rate — from about 15 blinks a minute to about 5 to 7. The 20-20-20 rule and deliberate blinking address the actual cause.
Is a dry eye visit covered by insurance? That depends on your plan. A medical dry eye evaluation and a routine vision exam are billed differently, and which of your benefits applies — along with what you owe — varies by payer, plan, and diagnosis. Prescription drops add a separate question about your drug coverage. The only reliable answer is the specific one, so ask the office to verify your benefits when you book, and confirm with your insurer.
Does Jackson Davenport treat dry eye? Yes. Medical eye care for conditions including glaucoma and dry eye is part of what the practice does, and a dry eye evaluation is a medical visit rather than a routine vision exam. Jackson Davenport is an optometric practice — the doctors evaluate and manage dry eye and refer out for surgical care when that is what a situation calls for.
Schedule a Dry Eye Evaluation in Summerville
If artificial tears stopped working, the useful next step is not a different bottle. It is finding out which part of the tear film is failing — the volume, the oil, the surface, or more than one — because that answer is what decides whether a prescription drop, a punctal plug, gland care, or a combination is the right plan for you.
Jackson Davenport Vision Center has been caring for Lowcountry families for more than 50 years, at 218 Old Trolley Road in Summerville, with two optometrists on staff — Dr. Christopher Holstead, O.D. and Dr. Alyssa Davenport, O.D. The office is open Monday through Friday from 8:00am to 5:30pm and Saturday from 9:00am to 1:00pm.
Call (843) 871-9750 or use our contact page to schedule a dry eye evaluation. If it has been a while since your last full workup, a comprehensive eye exam is a good place to start — dry eye is one of many things it screens for. You can also read about other common eye and vision conditions, or browse our full range of eye care services.
Bring your drops, bring your medication list, and bring the specific question you have been meaning to ask. That is what the visit is for.
This article is general information, not medical advice, and is not a substitute for an exam by a licensed eye doctor. Your eyes and your situation are unique, and nothing here diagnoses a condition or recommends a treatment for you. If you have a vision or eye-health concern, please schedule a comprehensive eye exam.