Lacrimal Sac Massage as an Effective Alternative to Probing in congenital nasolacrimal duct obstruction: JAMA
A new research published in the journal of JAMA Ophthalmology revealed that among infants younger than 1 year with congenital nasolacrimal duct obstruction (CNLDO), 3 months of lacrimal sac massage was noninferior to surgical probing in treatment efficacy. No serious complications occurred in either group. These findings support lacrimal sac massage as a safe, nonsurgical alternative to probing in appropriately selected infants.
CNLDO affects many newborns and infants, causing excessive tearing (epiphora) and recurring eye discharge due to a blocked tear duct. While many cases resolve naturally over time, treatment options have typically ranged from observation to surgical probing. Until now, evidence comparing the effectiveness of lacrimal sac massage with probing has remained limited and sometimes controversial.
This clinical trial was conducted at an outpatient clinic in Guangzhou, China, between April and September 2025. This research enrolled 160 infants younger than one year who had experienced persistent tearing or eye discharge since birth. Participants were randomly assigned to receive either lacrimal duct probing performed in the clinic or standardized lacrimal sac massage carried out regularly by parents at home.
After three months of follow-up, the massage group demonstrated outcomes comparable to those of the surgical group. Resolution of symptoms was achieved in 86.2% of infants receiving lacrimal sac massage, compared with 83.7% of those who underwent lacrimal duct probing. The difference of 2.5% points met the study's prespecified criteria for noninferiority, indicating that massage was not clinically inferior to the surgical procedure.
No serious complications was reported in either treatment group, reinforcing the safety of both approaches. However, symptom relief occurred more rapidly in infants who underwent probing. The average time to resolution was approximately 1.1 weeks in the probing group, when compared to 3.8 weeks among infants treated with massage, representing an average delay of about 2.7 weeks for the non-surgical approach.
Despite the slower recovery, this study noted that the comparable success rate, combined with the absence of surgical intervention, makes lacrimal sac massage an attractive first-line treatment option. Overall, the findings of this research suggest that standardized lacrimal sac massage can be considered a viable alternative to lacrimal duct probing for infants younger than one year with CNLDO who resemble those included in the study.
Reference:
Zheng, X., Yu, X., Wu, G., Zhang, J., Wang, K., Jin, L., Huang, S., Chen, R., Yu, H., Huang, W., Li, Z., & Liang, X. (2026). Standardized lacrimal sac massage vs probing for congenital nasolacrimal duct obstruction in infants: A noninferiority randomized trial: A noninferiority randomized trial. JAMA Ophthalmology. https://doi.org/10.1001/jamaophthalmol.2026.3169
