Upper Punctal Plug Occlusion in Previous Lower Punctal Occlusion.

Inclusion Criteria: * Patients of both sexes * One or both eyes may be included * Inferior lacrimal punctum occluded (with a punctal plug or cauterization), clinically sealed under slit-lamp examination * Functional superior lacrimal punctum * Aqueous-deficient dry eye (such as Sjögren's disease, graft-versus-host disease, or primary dry eye disease.) * Age \>18 years * OSDI score \>13 and one of the following signs: Tear film markers (Fluorescein tear break up-time \<5, First non-invasive tear breakup time \<10, Schirmer test without anesthesia \<10 mm, Schirmer test with anesthesia \<10 mm), Ocular surface markers (corneal staining \>5 spots or conjunctival staining \>9 spots). Exclusion Criteria: * Active ocular surface infection. * Patients who are unwilling to participate or to provide written informed consent.