Comparative Outcomes of Primary Probing Versus Lacrimal Sac Massage in Older Infants With Congenital Nasolacrimal Duct Obstruction.

Introduction Congenital nasolacrimal duct obstruction (CNLDO) is one of the most common causes of persistent epiphora and discharge in infants. While lacrimal sac massage is frequently advised as an initial therapy, the role of early probing in infants older than six months remains a subject of discussion. This study aimed to compare the outcomes of primary probing and lacrimal sac massage in infants aged 6-12 months with CNLDO.  Methods A prospective interventional study (non-randomized controlled trial) was conducted over a one-year period involving infants aged 6 to 12 months diagnosed with CNLDO. Participants were assigned to two groups: Group 1 underwent primary probing, while Group 2 was instructed to perform lacrimal sac massage for three months. Treatment success was defined as the absence of clinical signs of CNLDO, namely watering, increased tear lake, and mucoid discharge. Analysis of data was performed using IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 23. Armonk, NY: IBM Corp. Results A total of 128 infants were included; 48 children with CNLDO underwent primary probing, and 80 were treated with lacrimal sac massage. Probing achieved a significantly higher success rate (83.33%) compared to massage (25%). A chi-square test comparing the difference in success rates was highly statistically significant (p < 0.0001). Identified contributors to massage failure included poor compliance, improper technique, and recurrent upper respiratory infections.  Conclusion Based on the significantly superior success rates and favorable compliance observed in our patient cohort, our findings suggest that early referral to an ophthalmologist and a decision for primary probing may represent a more efficacious initial treatment strategy than prolonged massage in this specific age group. Further larger-scale, multi-center trials are warranted to confirm these findings and provide a comprehensive assessment of long-term complication rates for both modalities.