It just occurred to me, but when I first had my plugs put in for the very first time the doc told me my punctum was quite big. Is it possible that having natuarally large punctum was draining away too many tears in the beginning, eventually leading to my problems? I still don't really understand what caused my dry eye, I wasn't on any medication and I don't think I had any infection prior to that. One thing I do know is that I sleep with my eyes slightly open, but I know a couple of people who also do so and they have never had eye problems.