In infants with nasolacrimal duct obstruction, what is the initial management?

• A. Nasal massage
• B. Dilate and irrigate in the office
• C. Surgical intervention
• D. Observation without treatment

Answer: (A)

Initial management is lacrimal sac massage. Press gently on the lacrimal sac just beside the nose and toward the nostril several times a day to express mucus and help open the Hasner valve, promoting tear drainage. Many cases of congenital nasolacrimal duct obstruction resolve on their own within the first year, so starting with this simple, conservative approach is preferred. More invasive steps like dilation and irrigation or surgical probing are reserved if the obstruction persists or if recurrent infections occur despite massage. Observation without treatment isn’t ideal if tearing and discharge are present, though some mild cases can be monitored; the standard first step is nasal/lacrimal sac massage.