Hi there! The following is from an article on various chronic dry eye treatment (here: https://chronicdryeye.net/treatment ); but I wanted to pull out a quote that I hope helps answer your question. "The most severe cases of dry eye disease may require surgery to manage the condition. The most common type of surgery is punctal occlusion surgery by cautery. This procedure physically blocks the tear ducts that drain tears, which may restore the right balance of tears the eye needs. Other surgeries may involve changing the position or height of the eyelids to allow for more even distribution of tears or less exposure and evaporation of tears." Warmly - Reggie, team member