Dacryoadenitis

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Clinical Presentation

  • Inflammation of the lacrimal gland with painful swelling of the temporal upper lid
    • Pull the upper lid enough temporally to make the lacrimal gland visible
    • Subtarsal conjunctival inflammation
    • S-shaped upper eyelid due to swelling
  • Increased or reduced tear production possible
  • Slight bulbar displacement possible (inferiorly, nasally)

Causes

  • Inflammatory, non-infectious: Nonspecific orbital inflammation
    • Other: Sarcoidosis, IgG4-associated diseases, Sj√∂gren’s syndrome, thyroid eye disease, lymphoma
  • Viral (usually bilateral): Mumps, mononucleosis/EBV, adenovirus, influenza, varicella-zoster
  • Bacterial (usually unilateral): less common

Treatment

  • For suspected inflammatory, non-infectious origin:
    • consider systemic steroid therapy
    • consider biopsy
  • For suspected viral origin:
    • Voltaren 50mg p.o. 3x/day
    • Consider FML-NEO gtt 3x/day
  • For suspected bacterial origin:
    • Augmentin (amoxicillin/clavulanic acid) 1g p.o. 2x/day
    • Maxitrol gtt 4x/day
    • Initial daily follow-ups!

Sources

  • EyeWiki Dacryoadenitis
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)