Efficacy of Lacrimal Sac Massage in Management of Congenital Nasolacrimal Duct Obstruction in Infants: An Observational Study of 853 Cases from a Single Institute of Eastern Asia.

Purpose: Congenital nasolacrimal duct obstruction (CNLDO) is the most common cause of epiphora in infants. It usually resolves completely by the end of 1^st year with conservative management in most cases. Many studies have confirmed high frequency (80%-90%) of spontaneous resolution of symptoms during the 1^st year of life. The aim of this study is to determine the effectiveness of the lacrimal sac massage in the treatment of CNLDO.

Methods: The study was done in a tertiary care hospital in eastern Asia over 5 years. Each infant presenting with epiphora and diagnosed as CNLDO was treated with lacrimal sac massage and reviewed after every 1 month. The resolution of CNLDO was judged by the improvement of epiphora and from the fluorescein dye disappearance test.

Results: Following conservative management, 740 (86.75%) infants recovered completely after 3 months of continuous lacrimal sac massvage. One hundred and five (12.31%) infants did not recover with sac massage even at 12 months, in which cases probing was done. Repeat probing was needed in six patients (0.07%). Two patients did not recover, and a dacrocystorhinostomy was carried out. About 70.6% of infants recovered within 6 months of age. Earlier the age of presentation, the lesser the morbidity.

Conclusion: The incidence of CNLDO is about 6%-20% among infants. Several studies showed spontaneous resolution within 1^st year of life. In this study, the success rate of resolution of symptoms in CNLDO with sac massage is 86.75%. Conservative management should be the first line of treatment till 12 months of age in CNLDO.