Two entries from the Restasis FAQ are cryptic and don’t quite answer your question, but here they are;

“How is RESTASIS Ophthalmic Emulsion different from artificial tears?

Artificial tears temporarily lubricate the surface of the eye, but cannot increase tear production; RESTASIS® helps increase tear production in certain patients.

How is RESTASIS Ophthalmic Emulsion different from punctal plugs?

Punctal plugs can help keep tears on the surface of the eye longer, but cannot increase tear production; RESTASIS® increases tear production in Chronic Dry Eye patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca.”

and also;

“RESTASIS Ophthalmic Emulsion is indicated to increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca. Increased tear production was not seen in patients currently taking topical anti-inflammatory drugs or using punctal plugs”.

Here are some more comments that I think are also quite helpful Taking a Custom Approach to Dry Eye Treatment;.

“Every patient is different, so every treatment plan needs to be different. When I have a patient who is moderately-to-severely dry, I recommend artificial tears and then add Restasis and plugs. I stagger the onset of each modality so that I can determine the efficacy of each. In cases where the dry eye symptoms are severe enough, I start the patient on Restasis and plugs simultaneously. In even more severe cases, I often add systemic flaxseed oil and then Similasan #1, which is a homeopathic eye drop.

Here are more details about how I use the treatment options:

Punctal plugs. Collagen is my first choice. I insert two plugs in each of the lower punctum, and have patients return in 2 weeks to gauge the effect. If they feel a benefit, I add silicone plugs or Medennium Smart Plugs. The Medennium Smart Plugs are long-acting and unlike some silicone plugs have the added advantage of not protruding though the punctum. In my experience, they last anywhere from 6 months to a year. (I also keep in mind that plugging can occasionally worsen symptoms in some patients because inflammatory cells stay in the eye longer.) Some patients also need occlusion of their upper puncta.

Restasis. When I prescribe Restasis, I explain that the aim of the medication is to restore the ocular surface. I use uncomplicated language so patients can grasp the concept that Restasis gives the lacrimal gland a chance to produce more tears, and that the tears they’ll be making will be a better quality of tear and can “stick” to their eyes more effectively.”

davidp.