Inflammation of the lacrimal gland is called dacryoadenitis.
The most common etiology for dacryoadenitis is viral infection, with Epstein-Barr virus being the most common viral cause. Less common viral causes include adenovirus, varicella zoster, herpes simplex, rhinovirus, cytomegalovirus or mumps.
Bacterial causes include Staphylococcus aureus,
Besides infection, other etiologies include inflammatory causes such as non-specific orbital inflammation (NSOI), IGG4-related disease, or sarcoidosis, or neoplastic causes such as lymphoma, adenoid cystic carcinoma, or pleomorphic adenoma.
Potential risk factors include exposure to viral or bacterial agents or the presence of autoimmune disorders including Sjögren's syndrome, sarcoidosis or IgG4-related disease.
Signs of dacryoadenitis include tenderness, edema, or erythema overlying the superolateral orbit, conjunctivitis with or without chemosis, regional lymphadenopathy, proptosis of the globe. Fever may be present.
Symptoms of dacryoadenitis include pain in the superolateral orbit, pain with eye movements, ptosis or difficulty opening the affected eye, redness of the eye, and possibly diplopia.
A contrast-enhanced computed tomography (CT) scan of the orbits will typically demonstrate enlargement of the affected lacrimal gland with enhancement. There may be associated fat stranding.
If sarcoidosis is suspected, a chest radiograph is a reasonable screening tool to evaluate for lymphadenopathy or pulmonary disease.
Although there are no specific laboratory tests for dacryoadenitis, depending on the clinical context, it may be of use to obtain a complete blood count (CBC) with differential, erythrocyte sedimentation rate (ESR), and/or C-reactive protein (CRP) level to evaluate for leukocytosis and systemic inflammatory response. If autoimmune etiology is suspected, additional labs could include antinuclear antibody (ANA) screen, SS-A/SS-B antibodies, and serum IgG4 level.
Depending on the severity of the presentation, therapy could range from warm compresses to empiric treatment of bacterial infection, with or without the addition of systemic steroids.
Close follow up is warranted if there are orbital signs including decreased visual acuity, pain with eye movements, relative afferent pupillary defect, or abnormal color vision.
Although typically reserved for severe or recurrent cases, a biopsy of the lacrimal gland may be of diagnostic value if the etiology is in question.
There is limited data on complications of dacryoadenitis, however one case series reported ptosis affecting some patients, as well as a measurable (but clinically insignificant) decrease in tear production.
The prognosis of dacryoadenitis is generally good, with variability depending on the etiology. Viral dacryoadenitis is typically a self-limited disease, whereas idiopathic dacryoadenitis is more heterogeneous. One case series of 79 patients reported poor response to treatment in 37% of patients with idiopathic dacryoadenitis, and recurrent disease in 15% of the patients. The same series found that male sex and inflammation extending to an extraocular muscle were risk factors for incomplete treatment response, and that patients with bilateral dacryoadenitis had an increased risk of recurrent disease.
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