Dacryoadenitis
Background
Lacrimal system consisting of: of lacrimal gland (a), punctums (b,e), canalicules (c,f), lacrimal sac (g,d).
Lateral view of lacrimal anatamy.
- Ascension of agent from conjunctiva into lacrimal glands
- Anatomy
- Two lobes: orbital and palpebral lobes
- Palpebral lobe visualized by everting eyes
- Uncommon, with 1/10,000 ophthalmic patients having dacryoadenitis
Etiology
- Viral most common (mumps, EBV, HSV, CMV, echoviruses, coxsackie virus A)
- Bacterial
- S. Aureus and strep most common
- GC, syphilis, chlamydia, TB, mycobacterium leprae (leprosy), borrelia burgdorferi
- Fungal rare
- Inflammatory systemic (sarcoidosis, Graves' disease, Sjögren)
Clinical Features
Bilateral dacryoadenitis: erythema and edema are greatest over the lateral one-third of the upper eyelids
Chemosis and injection of the sclera
- Unilateral pain, redness, swelling, pressure in orbital supratemporal area
- Rapid onset, hours to days
- Chronic form > 1 mo
- May be bilateral
- May be painless
- More common than acute form
- Physical exam
- Chemosis, conjunctival injection, mucopurulent discharge
- Propotosis
- Swelling of lateral third of upper lid (S-shaped lid)
- Systemic signs
- Fever, URI, malaise
- Parotid gland enlargement
Differential Diagnosis
- Lacrimal gland tumor
Proptosis
- Normal IOP
- Orbital cellulitis
- Orbital pseudotumor
- Orbital tumor
- Increased IOP
- Retrobulbar abscess
- Retrobulbar emphysema
- Retrobulbar hemorrhage
- Orbital tumor
No proptosis
- Periorbital cellulitis/erysipelas
- Dacryocystitis (lacrimal duct)
- Dacryocele/Dacryocystocele
- Dacryostenosis
- Dacryoadenitis (lacrimal gland)
- Allergic reaction
- Nephrotic Syndrome (pediatrics)
Lid Complications
- Blepharitis (crusts)
- Chalazion (meibomian gland)
- Stye (hordeolum) (eyelash folicle)
Other
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Conjunctivitis
- Contact dermatitis
- Herpes zoster
- Herpes simplex
- Sarcoidosis
- Granulomatosis with polyangiitis
Neonatal eye problems
- Nasolacrimal duct obstruction
- Dacrocystitis
- Conjunctivitis
- Chemical
- Gonococcal
- Chlamydia
- Herpetic
- Streptococcus/S. Aureus
- Early onset glaucoma
- Uveitis
- Ocular foreign body
- Corneal abrasion
- Ocular trauma
- Ingrown eyelash
Evaluation
Bilateral dacryoadenitis
- CT orbits with contrast if concern for orbital cellulitis
- Bacterial culture, fungal if suspect
Management
- Warm compresses
- NSAIDs
- Based on etiology
- Bacterial - cephalexin 500mg q6 until culture results
- Add TMP-SMX (TMP 160mg q12hr) if concern for MRSA
- Protozoal or fungal - treat underlying infection
- Systemic, inflammatory/noninfectious - investigate underlying etiology
- Bacterial - cephalexin 500mg q6 until culture results
Disposition
- Outpatient ophtho referral
References
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