A 3 month old infant was brought with complaints of profuse lacrimation. On pressure pus exudes from the puncta. The best line of management is:
## **Core Concept**
The condition described in the question is indicative of **congenital nasolacrimal duct obstruction**, a common cause of excessive tearing (profuse lacrimation) in infants. This condition arises due to a failure of the nasolacrimal duct to canalize at birth, leading to a blockage that prevents normal tear drainage.
## **Why the Correct Answer is Right**
The best line of management for congenital nasolacrimal duct obstruction, especially when there is evidence of infection (as suggested by pus exuding from the puncta), involves addressing both the obstruction and the infection. **Probing of the nasolacrimal duct** is a procedure often recommended for infants with persistent obstruction beyond 6-9 months of age but in the presence of acute infection, initial management may involve **antibiotics** and **nasolacrimal massage**. However, given the acute presentation with pus, **probing under antibiotic cover** becomes a reasonable approach to relieve the obstruction and manage the infection.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is not provided, but typically, conservative management including nasolacrimal massage is tried first.
- **Option B:** Similarly, this option is not provided, but it might represent a less appropriate or outdated method.
- **Option C:** Without specifics, it's hard to judge, but generally, any option not involving direct addressing of the obstruction and infection would be less optimal.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that **nasolacrimal duct probing** is often successful in resolving congenital nasolacrimal duct obstruction and is usually considered if symptoms persist beyond 6-9 months of age. However, in cases with acute infection, as suggested by the presence of pus, **antibiotic therapy** should be initiated before or alongside probing to prevent the spread of infection.
## **Correct Answer:** . **Dacryocystorhinostomy (or probing under antibiotic cover)**