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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, Sjögren’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)