TOPLINE

In infants younger than 1 year with blocked tear ducts, gently massaging the tear sac was noninferior to in-clinic probing for clearing tearing and discharge symptoms, although massaging took longer to work.

METHODOLOGY

• Researchers conducted a noninferiority randomized clinical trial to compare the efficacy of massaging the lacrimal sac and probing the lacrimal duct for infants with congenital nasolacrimal duct obstruction. 
• They included 160 infants younger than 12 months (mean age, 6.2 months; 61% boys) at a Chinese center between April and September 2025. The infants had watery eyes or pus-like discharge in one or both eyes since birth.
• A total of 80 infants were randomly assigned to the massage group, with their caregivers trained in the massage technique and asked to perform it at least three times a day and submit check-ins or videos. The other 80 infants underwent one-time in-clinic probing under topical anesthesia.
• The primary outcome was complete or substantial resolution of watery eyes, along with complete resolution of pus-like discharge, at 3 months. Massage was considered noninferior if its success rate was no more than 10 percentage points lower than that of probing (the lower limit of CI stayed above -10 points).
• Secondary outcomes included recurrence of watery and purulent eye discharge during a 1-month extended follow-up period among patients who met the resolution criteria at 3 months. 

TAKEAWAY

• At 3 months, symptoms cleared in 86.2% of infants who received massage and 83.7% of those who received probing. The difference in resolution rates was 2.5 percentage points (95% CI, -8.78 to 13.76), and massage met the criteria for noninferiority. 
• The findings were similar in sensitivity analyses and analyses limited to infants who strictly adhered to their assigned treatment. 
• Symptoms resolved faster in infants who received probing vs massage (mean, 1.1 vs 3.8 weeks), with a difference of 2.7 weeks (P < .001). 
• No serious complications occurred in either group. The recurrence rate during the 1-month extended follow-up did not differ significantly between the groups. 

IN PRACTICE

“Healthcare professionals should enhance educational efforts for parents and caregivers to standardize the technique and improve treatment adherence,” the researchers reported.

The findings “support a standardized massage protocol as a reasonable initial management strategy for appropriately selected infants without extending conclusions beyond the population studied,” David I. Silbert, MD, and Heather F. Modjesky, COE, wrote in an invited commentary. 

SOURCE

The study was led by Xinyu Zheng, MD, of Guangdong Provincial Clinical Research Center for Ocular Diseases in Guangzhou, China. It was published online on August 13 in JAMA Ophthalmology.

LIMITATIONS

Families could not be masked for the interventions. Researchers could not accurately record how often or how well caregivers performed the massages. The 1-month observation period for recurrence was inadequate to assess long-term outcomes.

DISCLOSURES

The study received support from the Guangzhou Municipal School-Hospital Joint Research Fund and the State Key Laboratory of Ophthalmology. The authors did not report any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.