Update - Tear Duct Plugs

I now have just upper tear duct plugs, and they seem pretty sufficient for dry eye remedy.
I keep Systane Balance Eye Drops my opthalmologist told me to get and use them as needed (the purple box).

I believe the lower tear duct plugs were more effective, but for now, I am happy with just the upper plugs.

update - just upper ductal plugs now

Since having both upper and lower tear duct plugs caused me excessive tearing to a severe degree, I made an appointment to return to my opthalmologist.  One bottom one fell out, from my having to wipe my eyes so much because of the tear overflow.
So upon arrival we decided for me to retain the new upper ductal plugs and he removed the remaining lower plug.

One thing he told me I had not known before is to use warm moist compressions morning and night on the eyes and that it -- if done regularly - helps increase tear production so I must try this.

I note that the lower tear duct openings are still slightly enlarged after the plugs now being gone a week, but they should shrink back to normal size openings with time.

In the interim, for now, with just upper ductal plugs, I'm having more dry eye symptoms so will try the eye compresses.  Eventually if this doesn't work out, I'll find out about trying other types of plugs now on the market.  But hopefully this will be good enough to last for quite a while.

Update - having upper and lower tear duct plugs

Unfortunately having both upper and lower tear duct plugs caused my eyes to tear so bad, I was having to wipe my eyes all throughout the day and it was not good.
Then, from wiping them so often, the one lower plug came out.
So now I have 2 uppers and one lower plug.  The right eye has both plugs and is tearing badly.
The left is doing fine with just the upper plug.
I return to the doctor in a couple weeks.  He was going to remove a set but now since the one bottom one came out, I'll ask him if I can just keep the two new upper plugs and that he remove the one bottom plug.

I did some internet research and found this:

Welcome to Dry Eye Talk!

So 4x occlusion is too much and 2x is not enough? Maybe time to investigate different plug brands and designs if you have not already? In particular, perhaps EagleVision's flow controller plugs (which permit more drainage than their standard plugs) in the lowers might make having upper plugs more workable? Mind you I don't have much experience at all with the flow controllers, it just occurs to me as something that "sounds sensible" for this kind of situation.

http://www.dryeyezone.com/talk/showthread.php?1774-Any-advice-re-combination-of-upper-and-lower-punctal-plugs

There are several types of punctal plugs, which have different properties and uses depending on the material from which they are composed. They are commonly divided into punctal (or punctum) plugs, which are placed at the top of the puncta, with the tops visible and intracanalicular plugs, which are inserted into the canaliculus, and thus cannot be seen after insertion and need to be flushed out with irrigation for removal. In practice, both types are plugs are commonly referred to as “punctal plugs”. Collagen implants are dissolvable punctal plugs that may be used as a trial to assess if occlusion will ameliorate the patient’s symptoms and to rule out intolerable epiphora due from occlusion before irreversible punctal occlusion is performed. They dissolve within 4-7 days and do not cause complete canalicular occlusion. They are available in a variety of sizes and from a variety of manufacturers (see below for list of some manufacturers). Collagen implants may be used as a trial of punctal occlusion prior to more permanent treatment, for temporary enhancement of topical medications, for post-operative reduction of dry eyes and in the assessment of the effect of aqueous tear deficiency on ocular surface disease.

Of note, once a plug has been displaced from a punctum, subsequent plugs are more likely to be displaced from that punctum, and overdilation of the punctum should be avoided. There are several risks to the placement of silicone punctal plugs. The plugs can be advanced too deeply, causing inadvertent insertion into the nasolacrimal system, which necessitates surgical removal. Other risks of plug placement include the development of a pyogenic granuloma, canaliculitis, or dacryocystitis, although these are infrequent side effects. More common risks include spontaneous extrusion of the plug (which occurs in almost 40% of patients within the first six months), local irritation at the site of the plug, or epiphora which is intolerable to the patient. Excessive tearing is more common when both the upper and lower punctal are blocked. In cases of intolerable epiphora, the plug can be removed at the slit lamp. There are several companies which manufacture both collagen and silicone punctal plugs, including Eaglevision, US-IOL, FCI Ophthalmics, Delta Life Science, Odyssey, Angiotech, Medenium, Lacrimedics, Oasis and others. While collagen and silicone plugs have been available for some time, newer technologies have developed such as the SmartPLUG (by Medennium), which uses a hydrophobic acrylic polymer and the Oasis Hydrogel Intracanalicular Long-term Plug, which uses a hydrogel material. These materials change shape when exposed to body temperature and tears, respectively, allowing them to reshape into soft, gel-like plugs that occlude the punctum. In addition, silicone plugs have been modified to have varying shapes and sizes, with some designed to regulate the lacrimal drainage for cases in which total occlusion may cause epiphora. The Herrick dissolvable plugs (from Lacrimedics) function as medium-term occlusion treatment, lasting approximately 4-6 months. They have the same indications as collagen implants, but a longer duration of action. They are made of polydiaxonone and are placed in the horizontal canthus similarly to intracanalicular collagen implants.

http://www.eyevertise.com/Content/eye_exam/punctal_plugs/121lasik/punctal_plugs.aspx

If he removes the one lower plug and I do okay with the 2 new upper plugs, then the situation will be resolved. 

I hope that will fix everything and the 2 upper plugs will provide me with enough eye lubricant of tears so I don't have to investigate trying other types of plugs.

Again, all said and done, from my experience, I still highly recommend punctal plugs as a solution for dry eyes.  Not having red eyes, not having physical discomfort from dry eyes, not having to use artificial tears and eye drops constantly is a huge plus.  I use a computer at work and do a lot of reading documents with small print so it is imperative that my eyes are lubricated and maintained so they can perform their best.

On a side note, I turned 58 last month and my annual eye exam showed my vision has not changed for the last 2 years.  I use reading glasses and bifocals at work, and recently got the trifocals for 3 purposes in one pair of glasses:  reading, computer monitor viewing and distance.