This noninferiority RCT (n=160 infants <1 year, Guangzhou, China, April–September 2025) compared standardized lacrimal sac massage performed by parents vs. in-office lacrimal duct probing for congenital nasolacrimal duct obstruction (CNLDO), with the primary outcome of symptom resolution at 3 months.
Massage was noninferior to probing: resolution in 86.2% (69/80) vs. 83.7% (67/80) (difference +2.5 pp; 95% CI −8.78 to +13.76), exceeding the −10 pp noninferiority margin. No serious complications occurred in either group. Symptom resolution was faster with probing (1.1 vs. 3.8 weeks; difference 2.7 weeks; 95% CI 1.96–3.38; P<.001).
- Single-center study in China limits generalizability to other settings and ethnic groups. - Only the right eye was analyzed in bilateral cases, potentially missing asymmetric outcomes. - 3-month follow-up may not capture late recurrences or long-term outcomes.
For infants under 1 year with CNLDO, parent-performed lacrimal sac massage achieves resolution rates equivalent to office probing (~86% vs. ~84%), though probing resolves symptoms about 2.7 weeks faster. Clinicians can offer massage as a first-line, noninvasive alternative, reserving probing for families who prefer faster resolution.
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