From the Research
Conservative management with lacrimal sac massage should be the first line of treatment for congenital nasolacrimal duct obstruction (CNLDO) in infants, with a success rate of 86.75% as reported in the most recent study 1. The management of congenital nasolacrimal duct obstruction typically begins with conservative approaches before considering surgical intervention.
- Gentle massage of the tear duct 2-3 times daily is the first-line treatment, which helps open the membrane blocking the nasolacrimal duct.
- Warm compresses can also help reduce inflammation and discharge.
- If infection develops, antibiotic eye drops such as tobramycin 0.3% or polymyxin B-trimethoprim may be prescribed, typically 1 drop 3-4 times daily for 7-10 days. Most congenital tear duct obstructions (90%) resolve spontaneously by 12 months of age with conservative management, as supported by studies 2, 3, 4. For persistent blockages beyond 12 months, a probing procedure may be recommended, where a thin probe is inserted through the tear duct to open the blockage, with a success rate of 90% as reported in some studies 2, 5. However, the most recent and highest quality study 1 suggests that conservative management should be the first line of treatment till 12 months of age in CNLDO, with probing and other surgical procedures considered only after this age. Some studies also suggest that the success rate of probing may be higher in children with unilateral NLDO compared to those with bilateral NLDO 2. Overall, the management of congenital nasolacrimal duct obstruction should prioritize conservative approaches, with surgical intervention considered only when necessary and after careful evaluation of the individual case.