A 2 weeks old infant presents with excessive tearing in left eye, overflow of tears in the lower eyelid and frequent appearance of mucoid material for the last 1 week. The baby was delivered at home to a multigravida mother who had regular antenatal visits. There was no maternal or fetal complications perinatally. Most appropriate next step in management is:
Refer: Kanski s Clinical Ophthalmology: A Systematic Approach 8th edition pg 301 , AK KHURANA COMPREHENSIVE OPHTHALMOLOGY 6TH EDITION pg. No369
CONGENITAL DACRYOCYSTITIS
It is an inflammation of the lacrimal sac occurring in newborn infants
Treatment
It depends upon the age at which the child is brought.

Massage over the lacrimal sac area and topical antibiotics - up to 6-8 weeks of age, 4 times a day to be followed by instillation of antibiotic drops.
Lacrimal syringing (irrigation) with normal saline and antibiotic solution. It should be added
	to the conservative treatment if the condition is not cured up to the age of 2 months, once or twice a week.
Probing of NLD with Bowman’s probe. It should be performed, in case the condition is not cured
	by the age of 3-4 months, under general anaesthesia; may be repeated after an interval of 3-
	4 weeks.
Intubations with silicone tube may be performed if repeated probings are failure.
Dacryocystorhinostomy (DCR) operations: When the child is brought very late or repeated probing
	is a failure, after 4 years of age
Nasolacrimal sac massaging
Probing of nasolacrimal duct
Application of erythromycin drops
Instillation of steroid drops