I. Anatomical knowledge related to neonatal lacrimal sacs The lacrimal sac and the nasolacrimal duct are both components of the lacrimal drainage channel (referred to as the lacrimal duct). The lacrimal sac is located in the lacrimal fossa behind the medial canthal ligament and under the anterior aspect of the medial orbital wall, and is connected to the nasolacrimal duct at its lower end. The nasolacrimal duct is located within the bony nasolacrimal duct, which connects superiorly to the lacrimal sac and opens into the inferior nasal canal, and is the most recently formed of the tear drainage ducts. The lacrimal duct includes: upper and lower lacrimal dots, upper and lower lacrimal ducts, common lacrimal duct, lacrimal sac and nasolacrimal duct. The cause of neonatal dacryocystitis is mostly secondary to narrowing or obstruction of the nasolacrimal duct, which prevents tears from entering the lacrimal duct to enter the nasal cavity and remain in the lacrimal sac, accompanied by bacterial infection, which can result in mucopurulent discharge (manifested as increased “eye stool”), forming dacryocystitis. The possible causes of nasolacrimal duct stenosis or obstruction are: incomplete congenital development of the nasolacrimal duct without completing the “ducting”, partial or complete coverage of the opening of the nasolacrimal duct by the mucosal folds at the lower end of the nasolacrimal duct, nasal lesions (such as rhinitis, inferior turbinate hypertrophy, etc.) causing obstruction of the lower opening of the nasolacrimal duct, etc. The clinical features of neonatal lacrimal sacculitis are 1, lacrimation: many children have it since childhood. The child’s eyes often store tears, always tearful. 2, conjunctival secretions: secretions are mostly yellowish white, purulent, commonly known as “eye drops”, “eye mucus”. Most children have secretions since childhood. Antibiotic eye drops can reduce the discharge or even disappear, but after stopping the medication for a period of time, the discharge can appear again; if you gently press the lacrimal sac area (i.e., below the strip-like structure in the inner corner of the child’s eye) with your finger, you can often see a yellowish-white discharge overflowing from the tear dots. 3. It can develop in one eye or both eyes. The newborn lacrimal sac is suspected to have a lacrimal duct irrigation in the hospital. First confirm the diagnosis, then treatment: 1, local drugs: for children with both lacrimation and discharge. Generally give with local antibiotic eye drops dabbing eyes (such as tobramycin eye drops, 3 to 4 times a day). Before medication, regular pressure is applied to the lacrimal sac area of the child with fingers to squeeze out the secretions. Medication can only temporarily reduce the symptoms. 2.Local massage: the purpose of massage is to promote the nasolacrimal duct patency. (1) Massage before confirming the location of the tear sac: in the inner corner of the affected eye (i.e., the inner canthus), feel with your fingers from above to below, touching a horizontal strip, that is, the inner canthal ligament; below the inner canthal ligament (i.e., the deep side, if the child is sitting, deep that is, backward) is the tear sac; below the tear sac is connected to the nasolacrimal duct (i.e., from the inner corner of the eye to the direction of the nose). (2) Massage method: use the thumb or index finger (note that the nail should be cut short, repair round and smooth, do not hurt the child), gently to the inner (nasal bridge direction), under (nasal wing direction), deep (if the child is sitting, deep that is backward) at the appropriate force to press. Massage with which hand, which finger, depending on the habit. 3, tear duct flushing: flushing the tear duct with saline can flush out the secretions in the tear sac, and at the same time, the lower end of the nasolacrimal duct can be opened with the pressure of the water; antibiotic solution can be injected after tear duct flushing; 4, tear duct exploration: if the nasolacrimal duct is still inaccessible after the child is half a year old, tear duct exploration can be considered (the procedure is very simple and belongs to outpatient minor surgery). V. Suggestions Since most neonatal dacryocystitis can heal spontaneously with age, or heal with local massage, it is not recommended to rush to surgery (local massage can be done under the guidance of the doctor to promote the opening of the lower end of the nasolacrimal duct; at the same time, local antibiotic eye drops can be ordered to reduce inflammation and prevent the spread of inflammation); if the child does not heal spontaneously after the age of half a year, then consider performing lacrimal duct exploratory surgery.