BACKGROUND Infantile acute dacryocystitis is due to congenital nasolacrimal duct obstruction (NLDO) in newborns and infants, which involves acute bacterial infection of the lacrimal sac. This report describes a 37-day-old male infant with acute dacryocystitis and lacrimal abscess managed with a modified decompression and nasolacrimal duct probing. CASE REPORT We report the case of a 37-day-old male infant who presented with acute dacryocystitis complicated by a giant lacrimal abscess. On day 30 of life, his parent brought him to a local clinic due to inferior eyelid edema and hyperemia. He was diagnosed with acute dacryocystitis and was treated with tobramycin eye drops and ointment. However, severe erythema, swelling, and tenderness over the lacrimal sac area persisted. The parent refused a head CT, ultrasound examination, and systemic antibiotics, and brought the infant to our emergency unit for a second opinion on day 37 of life. A modified decompression and probing approach was employed, which involved gentle decompression of the abscess to relieve tension, followed by probing of the nasolacrimal duct to restore proper drainage. After a repeat decompression and probing procedure, the dacryocystitis and giant lacrimal abscess disappeared gradually, with good esthetic results. The infant responded well to the treatment, with resolution of symptoms and no recurrence of the abscess during follow-up. CONCLUSIONS This case demonstrates that our modified decompression and probing approach provides a practical and an alternate option to treat acute dacryocystitis in infants complicated by a giant lacrimal abscess.