[Generated for Academic Review] Journal: Journal of Ophthalmic Nursing & Clinical Practice (Hypothetical) Date: April 2026 Abstract Background: Lacrimal duct massage, primarily known as the Crigler massage, is a non-invasive therapeutic maneuver used to manage nasolacrimal duct obstruction (NLDO), particularly in congenital cases. The technique aims to increase hydrostatic pressure within the lacrimal sac to rupture the distal membrane (Hasner’s valve) and establish patent nasolacrimal drainage. Objective: This paper reviews the anatomical basis, procedural techniques, clinical indications, and current evidence regarding the efficacy of lacrimal duct massage. Methods: A narrative synthesis of clinical guidelines, anatomical studies, and randomized controlled trials (RCTs) from 2000–2025 was conducted. Results: Evidence supports a high spontaneous resolution rate (over 80%) for congenital NLDO with conservative management including massage. However, significant variability exists in massage technique (direction, frequency, force), affecting outcomes. Adjunctive use with topical antibiotics shows moderate benefit in preventing secondary infection (dacryocystitis). Conclusion: Lacrimal duct massage is a safe, cost-effective first-line therapy. Standardized parental/caregiver education and consistent technique are critical for success.

Lacrimal Duct Massage: Techniques, Indications, and Evidence in the Management of Nasolacrimal Duct Obstruction

Perform hand hygiene. Trim fingernails. Position the infant supine or held securely by a parent.

Lacrimal duct massage, Crigler massage, nasolacrimal duct obstruction, congenital epiphora, dacryocystitis 1. Introduction Nasolacrimal duct obstruction (NLDO) is the most common cause of persistent tearing (epiphora) and ocular discharge in infants, affecting approximately 5-20% of newborns (Schnall, 2023). The condition arises from the failure of the distal end of the nasolacrimal duct—the valve of Hasner—to spontaneously open during fetal development or shortly after birth.

A landmark RCT by Kushner (1982) and a later meta-analysis by Petris and Liu (2017) found that .