Dacryoadenitis

Inflammatory condition of the lacrimal gland

Aetiology

Infectious Causes

  1. Bacterial
      • Staphylococcus aureus (most common)
      • Streptococcus species
      • Haemophilus influenzae
  1. Viral
      • Epstein–Barr virus (EBV)
      • Mumps virus (most common)
      • Influenza virus
      • Herpes simplex virus (HSV)
  1. Mycobacterial and Fungal (rare)
      • Mycobacterium tuberculosis
      • Fungal organisms in immunocompromised patients

Non-Infectious Causes

  1. Inflammatory / Autoimmune
      • Sarcoidosis
      • Sjögren syndrome
      • IgG4-related disease
      • Granulomatosis with polyangiitis
  1. Systemic Diseases
      • Thyroid eye disease (rare involvement)

    Clinical presentation

    Symptoms

    • Acute onset of pain in the superolateral orbit
    • Swelling of the upper eyelid
    • Redness and warmth over the lacrimal gland region
    • Epiphora
    • Fever and malaise (especially in infectious cases)

    Signs

    • Tender, firm swelling in the superotemporal orbit
    • S-shaped ptosis of the upper eyelid
    • Conjunctival injection overlying the gland
    • Restricted ocular motility in severe cases
    • Possible bilateral involvement in systemic disease
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    Investigations

    Clinical Evaluation

    • Detailed history (onset, systemic symptoms, recurrence)
    • Complete ophthalmic examination including visual acuity and ocular motility
    • Anel Test positive

    Laboratory Studies

    • Complete blood count (CBC)
    • Inflammatory markers (ESR, CRP)
    • Viral serology (e.g., EBV) when indicated
    • Autoimmune markers (ANA, ANCA, serum IgG4) in chronic or bilateral cases

    Imaging

    CT or MRI of the orbit to assess gland enlargement, abscess formation, or orbital involvement

    Biopsy

    • Indicated in:
      • Chronic or recurrent dacryoadenitis
      • Atypical presentations
      • Suspected neoplastic or IgG4-related disease

    Management

    Acute Infectious Dacryoadenitis

    • Systemic broad-spectrum antibiotics (tailored to suspected organism)
    • Analgesics and anti-inflammatory agents
    • Hospitalization if severe or systemic involvement is present

    Viral Dacryoadenitis

    • Supportive care
    • Antivirals if indicated (e.g., HSV)

    Non-Infectious / Autoimmune Dacryoadenitis

    • Systemic corticosteroids (after excluding infection)
    • Immunosuppressive therapy for refractory or systemic disease
    • Management of underlying systemic condition