Dacryoadenitis

Background

  • Ascension of agent from conjunctiva into lacrimal glands
  • Anatomy
    Orbital and palpebral lobes.JPG
    • Two lobes: orbital and palpebral lobes
    • Palpebral lobe visualized by everting eyes
  • Uncommon, with 1/10,000 ophthalmic patients having dacryoadenitis

Etiology

Clinical Features

  • 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

Periorbital swelling

Proptosis

No proptosis

Lid Complications

Other

Neonatal eye problems

Evaluation

  • 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

Disposition

  • Outpatient ophtho referral

References