The study compared the efficacy of combination therapy of 0.05% cyclosporin A (CsA) with absorbable inferior punctal plugs versus CsA monotherapy in patients with dry eye associated with Sjögren's syndrome using a randomized, paired-eye design. One eye of each patient received combined treatment, the contralateral eye only CsA. Parameters such as OSDI index, visual analogue scale (VAS), non-invasive tear break-up time (NIBUT), tear meniscus height (TMH) and corneal dendritic cell (DC) density measured in vivo by confocal microscopy at baseline and after 3 months were evaluated. After 3 months, both groups showed significant improvements in all parameters (p < 0.01). The combination treatment group had significantly greater improvement in NIBUT (p < 0.01), TMH (p < 0.05), DC density (p < 0.01), and VAS (p < 0.01) compared to monotherapy. A significant positive correlation between ΔVAS and ΔOSDI (r = 0.528, p = 0.014) was found in the combined group, but not in monotherapy (r = -0.172, p = 0.456). The study is registered under the identifier NCT07171710.