From the Research
For a 3-week-old infant with nasolacrimal duct obstruction, the recommended initial treatment is 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 apply hydrostatic pressure in the lacrimal sac, potentially opening the membrane at the end of the nasolacrimal duct 1. Warm compresses can also help if there is discharge. Antibiotic eye drops (such as polymyxin B-trimethoprim or erythromycin ophthalmic ointment) may be prescribed if there is significant conjunctivitis or discharge, but are not routinely needed. Most cases (90-95%) resolve spontaneously by 12 months of age without surgical intervention, as supported by a review of treatment options for congenital nasolacrimal duct obstruction 2.
Key Considerations
- The obstruction is typically due to a membranous block at the distal end of the nasolacrimal duct that often opens naturally as the infant grows.
- If symptoms persist beyond 12 months of age or if there are recurrent severe infections, probing of the nasolacrimal duct by an ophthalmologist may be necessary, but this is rarely performed before 12 months unless complications develop, as discussed in a study on probing for congenital nasolacrimal duct obstruction 3.
- A comparison of treatment approaches for bilateral congenital nasolacrimal duct obstruction found that both immediate office probing and observation with deferred facility probing are successful and reasonable treatment options 4.
- Repeat probing can be considered for persistent nasolacrimal duct obstruction, with a reported success rate of 56% in one study 5.
Treatment Approach
- Conservative management with gentle massage and observation is the recommended initial treatment.
- Probing of the nasolacrimal duct may be considered if symptoms persist beyond 12 months of age or if there are recurrent severe infections.
- Antibiotic eye drops may be prescribed if there is significant conjunctivitis or discharge.
- Warm compresses can help if there is discharge.