Massage Clogged Tear Duct: How To

REPORT: Guidelines for the Management and Massage of a Clogged Tear Duct (Nasolacrimal Duct Obstruction) Date: October 26, 2023 Subject: Standard Operating Procedure for Lacrimal Sac Massage (Crigler Massage)

1. Executive Summary This report outlines the etiology, indications, and step-by-step methodology for performing lacrimal sac massage, commonly referred to as "clogged tear duct massage." This non-invasive technique is the first-line conservative treatment for nasolacrimal duct obstruction (NLDO), particularly in infants. The procedure aims to relieve stasis of tears, reduce the risk of infection (dacryocystitis), and potentially open the membranous obstruction at the valve of Hasner. 2. Introduction and Anatomy The tear duct (nasolacrimal duct) drains tears from the eye into the nose. A blockage often occurs when a thin membrane at the end of the duct fails to open fully before birth.

Anatomy involved: The lacrimal sac sits in the bony fossa between the eye and the bridge of the nose. Goal of Massage: To apply hydrostatic pressure within the lacrimal sac, forcing fluid downward to rupture the obstructing membrane or dislodge debris.

3. Indications and Contraindications Indications: how to massage clogged tear duct

Persistent tearing (epiphora) without redness of the eye. Mucoid or purulent discharge from the eye (indicating stasis). Maternal report of "sticky eye" in newborns.

Contraindications:

Acute Dacryocystitis: If the area between the eye and nose is red, swollen, warm to the touch, or painful, massage should NOT be performed. Massaging an infected area can spread bacteria into the orbit, leading to cellulitis. Trauma: Fracture or injury to the orbital bones. REPORT: Guidelines for the Management and Massage of

4. Preparation and Safety Before beginning the procedure, strict hygiene is required to prevent introducing bacteria into the eye.

Hand Hygiene: Wash hands thoroughly with soap and warm water. Short Nails: Ensure fingernails are trimmed short to avoid scratching the delicate skin or the infant's eye. Positioning: The patient (if an infant) should be laid on their back or held in a secure position. Cleaning: Use a warm, damp washcloth or sterile gauze to gently wipe away any crust or discharge from the eyelids. Wipe from the inner corner outward.

5. Procedure: The Crigler Massage Technique This is the standard method recommended by pediatric ophthalmologists. Step 1: Location Identification Locate the lacrimal sac , which sits just below the inner corner of the eye (the medial canthus) and slightly above the bony ridge of the nose. Anatomy involved: The lacrimal sac sits in the

Note: Do not massage the eyeball itself.

Step 2: Placement Place the pinky finger (due to its small size and soft pressure) or the index finger against the side of the nose, level with the inner corner of the eye. Step 3: The Stroke Apply firm, steady pressure against the bony side of the nose (not the soft tissue of the cheek).