mtpeony, An optometrist can actually insert the punctual plugs. There is nothing too it. The first pair is made out of collagen and they dissolve in 2-3 weeks. This is to see if you tolerate them well before going to the permanent silicone plugs. They numb your eyes and insert the plugs. Takes about 10 min. My eyes are so much better from the dryness/inflammation. I'm using less Systane drops and hope to get off even more drops. Still on Lotamax (almost finished), Restasis & Systane Complete. I may be able to get off the Restatsis as well. I'm sure there is a doctor in your area that can do this procedure. You drive home from the procedure with no pain. No more tearing & eye pain for me. I do still have some dryness...but nothing like it was. So grateful. I wish you the very best on this.