What is Dacryoadenitis?
Dacryoadenitis is inflammation of the main or accessory lacrimal gland. The lacrimal gland secretes tears. The condition can be infectious or noninfectious. Dacryoadenitis can be the presenting sign of an undiagnosed systemic disease like lymphoma. Around half of lacrimal gland mass lesions are diagnosed as dacryoadenitis. Tissue diagnosis and systemic investigations are key to correct diagnosis.
- Dacryoadenitis is an inflammatory condition of the lacrimal gland.
- Diagnosis may require a biopsy to rule out a systemic condition.
- Treatment depends on the cause.
Dacryoadenitis may be caused by infections, may be idiopathic, or the result of an autoimmune condition. Viruses, fungus or parasites are possible etiologies. Other causes of inflammation include autoimmune disorders such as Thyroid Eye Disease, Sjogren’s syndrome and IgG4 related disease.
The most common infectious etiology for dacryoadenitis is viral, more specifically, Epstein-Barr virus. Less common viral causes include adenovirus, varicella zoster, herpes simplex, rhinovirus, cytomegalovirus, or mumps.
Bacterial infections include Staphylococcus aureus, especially methicillin-resistant S. aureus, and Streptococcus species. In endemic risk areas, tuberculous infections and abscesses have been described.
Besides infections, other etiologies include inflammatory causes such as nonspecific orbital inflammation (NSOI), IgG4-related disease, sarcoidosis, or neoplastic causes such as lymphoma, adenoid cystic carcinoma, or pleomorphic adenoma.
Risk Factors for Dacryoadenitis
Risk factors include exposure to viruses or bacteria, or autoimmune disorders including Sjogren’s syndrome, sarcoidosis, or IgG4-related disease.
- Tenderness, redness, edema over superior-lateral orbit
- Pain around the eyes or with eye movement
- Double vision
- Lid drooping (ptosis)
- Redness of the conjunctiva w or w/o swelling
- Regional lymph node swelling
- Eye proptosis
- Limitations of eye movement
- Rare cases of vision loss
Diagnostic procedures and laboratory tests can be used for diagnosis. 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 with contiguous involvement of the lateral rectus and /or superior rectus/levator muscle complex.
If sarcoidosis or other specific orbital inflammatory disorders are suspected, a chest radiograph is a reasonable screening tool to evaluate for lymphadenopathy or pulmonary disease.
In children and in adults with persistent/recurrent symptoms, Magnetic Resonance Imaging (MRI) of the orbits may also be considered.
There are no specific laboratory tests for dacryoadenitis, but 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 may be helpful.
If dacryoadenitis is secondary to overlying viral conjunctivitis, a conjunctival swab for PCR or cultures may be considered. If autoimmune etiology is suspected, additional labs could include antinuclear antibody (ANA) screen, SS-A/SS-B antibodies, and serum IgG4 level. If Thyroid Eye Disease is suspected, a thyroid function test panel with autoimmune antibodies may also be ordered by your doctor.
Depending on the severity, the condition may be observed or treated. Treatment depends on the cause. Bacterial dacryoadenitis will require systemic broad-spectrum antibiotics and, if indicated, abscess drainage. Oral corticosteroids may be considered in cases like idiopathic dacryoadenitis.
In cases that do not respond to other treatments, patients may benefit from orbital radiation or systemic therapy such as rituximab or methotrexate. A tissue biopsy should be considered if there is concern for an atypical infection or malignant disease.