External digital massage is performed by applying moderate pressure over the lacrimal sac in a downward direction for 2 to 3 seconds & two to three times per day until symptoms resolve. Topical antibiotics may be helpful in controlling bacterial overgrowth in case of purulent eye discharge. Infants with symptoms of NLD obstruction that have not resolved by age six to seven months should be referred to an ophthalmologist.
The optimal timing of probing for infants with congenital NLD obstruction is an area of controversy. Many ophthalmologists perform early probing if symptoms have not resolved by the age of 6 to 10 months.
The advantages of probing at this age compared with deferring the procedure until the child is ≥12 months of age are earlier resolution of symptoms, lesser risk of infection and lacrimal duct scarring. The only school of thought against an early surgical intervention is that, because the rate of spontaneous resolution is high, some children may undergo unnecessary probing.
Hence, to defer a surgical intervention until after 12 months of age and to allow more time for spontaneous resolution is an acceptable option for NLD obstruction.