Nasolacrimal Duct Massage Technique for Elderly Patients with Blocked Tear Ducts
For elderly patients with acquired nasolacrimal duct obstruction, massage of the lacrimal sac area is generally ineffective and should not be the primary treatment approach; instead, refer promptly for surgical evaluation with dacryocystorhinostomy (DCR). 1
Why Massage is Not Recommended for Elderly Patients
- Nasolacrimal duct massage is primarily a conservative treatment for congenital nasolacrimal duct obstruction in infants and young children, not for acquired obstruction in elderly adults 2, 3
- Acquired nasolacrimal duct obstruction in middle-aged and elderly patients (particularly women) represents a fundamentally different pathology than congenital obstruction, typically involving complete or partial blockage of the bony nasolacrimal duct 1
- The success rate of conservative massage therapy even in pediatric populations is only approximately 30%, and this drops further with age and the presence of mucoid discharge 3
If Massage is Attempted Despite Limited Evidence
Should you choose to trial massage before surgical referral, the technique involves:
- Apply firm digital pressure over the lacrimal sac area (located at the medial canthus, just below the medial canthal tendon) 3
- Direct pressure downward and inward toward the nose to attempt expression of any obstructed material and promote opening of the duct 2
- Perform 2-3 times daily for several weeks if attempting conservative management 2
- Assess for regurgitation on pressure over lacrimal sac (ROPLAS): if mucoid or purulent material regurgitates, this indicates a higher likelihood of treatment failure and need for surgical intervention 3
Critical Caveats for Elderly Patients
- Dacryocystitis risk: Acquired nasolacrimal duct obstruction is the predominant underlying cause of both acute and chronic dacryocystitis (infection of the tear sac), which can lead to serious complications 1
- Manual dexterity concerns: Elderly patients may lack the manual dexterity or judgment to perform massage safely, particularly if they have arthritis, tremor, or visual impairment 4
- Corneal injury risk: Improper technique can cause corneal abrasion or other ocular surface damage 4
Appropriate Management Algorithm for Elderly Patients
The primary eye care provider should:
- Diagnose the obstruction through assessment of tear film, punctal position, and nasolacrimal system patency 5
- Refer promptly for surgical evaluation rather than prolonged conservative management 1
- Recognize that dacryocystorhinostomy (DCR) is the definitive treatment for acquired nasolacrimal duct obstruction in adults 1
- Monitor for signs of dacryocystitis (pain, swelling, erythema over lacrimal sac area, fever) which requires urgent treatment 5, 1
Massage is not a substitute for appropriate surgical referral in elderly patients with acquired nasolacrimal duct obstruction.