From the Research
For nasolacrimal duct obstruction in a 2-week-old infant, the initial treatment approach should be conservative management with gentle massage and observation. Parents should be taught to perform lacrimal sac massage 2-4 times daily by placing a clean finger over the inner corner of the eye and applying gentle pressure downward toward the nose. This massage helps to open the membrane at the end of the nasolacrimal duct and facilitate drainage. Additionally, parents should clean any discharge with a clean, warm, damp cloth, wiping from the inner to outer corner of the eye. Antibiotic eye drops such as erythromycin or polymyxin B-trimethoprim may be prescribed if there is significant conjunctivitis or discharge, typically used 3-4 times daily for 7-10 days. Most cases (90-95%) resolve spontaneously by 12 months of age without further intervention 1. If symptoms persist beyond 12 months, or if there are severe recurrent infections, referral to an ophthalmologist for possible probing of the nasolacrimal duct may be necessary.
The conservative approach is recommended because the obstruction is typically due to a membrane at the distal end of the nasolacrimal duct that often opens naturally during the first year of life. A stepwise treatment paradigm, including probing, balloon catheter dilation, and silicone intubation, can be considered for patients who fail conservative management 2. However, for a 2-week-old infant, conservative management is the most appropriate initial approach.
Some studies have reported the use of nasal endoscopic-assisted probing and modified decompression and probing approaches for the management of congenital nasolacrimal duct obstruction 3, 4. However, these approaches are typically considered for older infants or children who have failed conservative management or have more complex cases of nasolacrimal duct obstruction.
In summary, the key points to consider in the management of nasolacrimal duct obstruction in a 2-week-old infant are:
- Conservative management with gentle massage and observation as the initial approach
- Cleaning of any discharge with a clean, warm, damp cloth
- Use of antibiotic eye drops if necessary
- Referral to an ophthalmologist for possible probing if symptoms persist beyond 12 months or if there are severe recurrent infections. The most recent and highest quality study 1 supports the use of conservative management as the initial approach for nasolacrimal duct obstruction in infants.