Outcomes of Lacrimal Sac Hydrostatic Pressure Application in Congenital Nasolacrimal Duct Obstruction in Infants: A Retrospective Cohort Study

Background: Congenital nasolacrimal duct obstruction (CNLDO) is a common ocular disorder in infants characterized by persistent epiphora and mucopurulent discharge caused by blockage of the nasolacrimal duct. Although many cases resolve spontaneously within the first year of life, conservative management is usually recommended as the initial treatment. Lacrimal sac hydrostatic pressure application (HPA), a physician-performed pressure technique, has been proposed as an effective office-based intervention to relieve obstruction and accelerate symptom resolution. Aim: To evaluate the efficacy and safety of lacrimal sac hydrostatic pressure application as a conservative treatment for infants with congenital nasolacrimal duct obstruction. Methods: This retrospective cohort study included 179 infants (261 eyes) diagnosed with CNLDO who underwent HPA performed by a pediatric ophthalmologist. The procedure involved applying controlled downward pressure over the lacrimal sac to generate hydrostatic force within the nasolacrimal duct. Treatment success was defined as complete resolution of epiphora and/or mucopurulent discharge within 48 hours after the procedure. Patients were followed with a mean follow-up duration of 11.6 ± 13 months, and statistical analyses including logistic regression were used to determine predictors of success. Results: Complete resolution after the first HPA occurred in 102 eyes (39.1%). Infants aged ≤6 months had significantly higher success compared with older infants (43.7% vs 30.9%, p = 0.04). Younger age was a significant predictor of success. A second HPA resulted in additional resolution in 12 eyes (26.1%) without major complications. Conclusion: Lacrimal sac hydrostatic pressure application is a safe, practical, and effective conservative treatment for CNLDO, particularly in infants younger than six months, and may reduce the need for surgical intervention.