Dacryoadenitis refers to inflammation of the lacrimal gland and may be unilateral or bilateral. The lacrimal gland is located superotemporally to the globe, within the extraconal orbital fat. The gland consists of palpebral and orbital lobes, which are separated by the lateral horn of the levator aponeurosis. Inflammation of the gland can be due to infectious or inflammatory sources but may be idiopathic. Viral dacryoadenitis is self-resolving, while bacterial sources may require antibiotic administration. Inflammatory causes may respond to steroids, or demonstrate a chronic relapsing course requiring long-term treatment to maintain remission.
Dacryoadenitis refers to acute or chronic inflammation of the lacrimal gland and can be due to infectious, inflammatory, or idiopathic causes. Acute dacryoadenitis is most common in children and young adults and typically presents with erythema and tenderness over the superotemporal orbit with enlargement of the gland causing the lateral portion of the eyelid to fall, creating a characteristic S-shaped curve of the eyelid margin. There can also be associated suppurative discharge from lacrimal ducts, pouting of the lacrimal ductules, conjunctival chemosis, and swelling of preauricular and cervical lymph nodes. Fever and malaise may be present. Inflammatory causes of dacryoadenitis may present subacutely with typically painless swelling of the lacrimal glands and may be bilateral. Acute lacrimal gland swelling that presents in association with a viral illness does not require a biopsy or comprehensive laboratory evaluation. However, if there are atypical features or if the swelling does not resolve with treatment, an additional workup is merited. Occurrence in older adults, bilateral presentation, and systemic symptoms may suggest a malignant or systemic autoimmune process, in which case additional workup is strongly advisable. This activity reviews the presentation, evaluation, and management of dacryoadenitis and stresses the role of an interprofessional team approach to care for affected patients.
Causes
Dacryoadenitis is the inflammation of the lacrimal gland, which is responsible for producing tears. While there can be various causes for this condition, here is a list of 30 potential causes for dacryoadenitis:
- Bacterial infection (such as Staphylococcus aureus or Streptococcus pneumoniae)
- Viral infection (such as Epstein-Barr virus or mumps virus)
- Tuberculosis
- Syphilis
- Sarcoidosis
- Autoimmune diseases (such as Sjögren’s syndrome)
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Granulomatosis with polyangiitis (formerly Wegener’s granulomatosis)
- Lymphoma (Hodgkin’s or non-Hodgkin’s)
- Leukemia
- Metastatic cancer (spread from other parts of the body)
- Thyroid eye disease (Graves’ ophthalmopathy)
- Parinaud’s oculoglandular syndrome (caused by cat-scratch disease or tularemia)
- Orbital cellulitis (infection of the tissues around the eye)
- Sinusitis (infection or inflammation of the sinuses)
- Trauma or injury to the lacrimal gland area
- Radiation therapy to the head and neck region
- Chemical burns or exposure to irritants
- Allergic reactions
- Kawasaki disease (an inflammatory condition affecting children)
- Langerhans cell histiocytosis
- Mucormycosis (a fungal infection)
- Amyloidosis
- Leprosy
- Malignant melanoma
- Cat-scratch disease
- Lyme disease
- Parasitic infections (such as toxoplasmosis)
- Medications (certain drugs can cause an allergic or inflammatory reaction)
It’s important to note that this list is not exhaustive, and there may be other potential causes for dacryoadenitis. If you suspect you or someone you know has dacryoadenitis, it’s recommended to consult a healthcare professional for an accurate diagnosis and appropriate treatment.
Symptoms
The symptoms of dacryoadenitis can vary depending on the underlying cause and the severity of the inflammation. Here is a list of 20 common symptoms associated with dacryoadenitis:
- Eye pain: Individuals with dacryoadenitis may experience discomfort or aching pain in or around the affected eye.
- Swelling: The lacrimal gland may become swollen and enlarged, leading to a visible bulge in the upper outer corner of the eye.
- Redness: The affected eye may appear red or bloodshot due to the inflammation of the lacrimal gland.
- Tenderness: The lacrimal gland can be tender to touch, causing pain or sensitivity in the area.
- Watery eyes: Dacryoadenitis can disrupt the normal tear production and drainage process, resulting in excessive tearing or watery eyes.
- Dry eyes: Paradoxically, some individuals may also experience dryness in the affected eye due to the disruption of tear production.
- Eye discharge: The inflammation may lead to the production of excessive mucus or pus-like discharge from the affected eye.
- Eye irritation: The presence of inflammation and excessive tearing can cause irritation, itching, or a gritty sensation in the eye.
- Blurred vision: In some cases, dacryoadenitis can cause temporary blurred vision due to the disruption of tear film stability.
- Eye fatigue: Individuals may experience eye fatigue or strain, especially if the inflammation persists for an extended period.
- Sensitivity to light: The inflamed lacrimal gland can make the affected eye more sensitive to bright light, leading to discomfort or photophobia.
- Eyelid swelling: In addition to the swelling of the lacrimal gland, the surrounding eyelid may also become swollen or puffy.
- Eye discharge: Along with excessive tearing, the affected eye may produce a thick, sticky, or yellowish discharge.
- Eyelid redness: The inflammation may extend to the eyelid, causing redness or a pinkish discoloration.
- Headache: Some individuals with dacryoadenitis may experience headaches, particularly if the pain radiates from the affected eye.
- Fever: If the underlying cause of dacryoadenitis is an infection, individuals may develop a fever as a systemic response.
- Fatigue: The inflammation and associated symptoms can lead to general fatigue or a feeling of tiredness.
- Swollen lymph nodes: Depending on the cause, the nearby lymph nodes may become enlarged and tender to touch.
- Limited eye movement: Severe swelling or pain may restrict the movement of the affected eye, causing difficulty in looking around.
- Systemic symptoms: In some cases, individuals may experience general malaise, loss of appetite, or other systemic symptoms, particularly if the cause of dacryoadenitis is an underlying autoimmune disorder.
It’s important to note that these symptoms can vary in intensity and duration depending on the individual and the underlying cause of dacryoadenitis. If you suspect you may have dacryoadenitis, it’s recommended to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.
Diagnosis
It can occur due to various causes, including infection, autoimmune disorders, and trauma. The diagnosis of dacryoadenitis involves a combination of clinical evaluation, medical history, and specific tests. Here is a list of 20 common diagnostic procedures and tests used for the diagnosis of dacryoadenitis:
- Medical history: The first step in diagnosing dacryoadenitis is taking a detailed medical history of the patient, including the onset and duration of symptoms, previous medical conditions, and any relevant family history.
- Physical examination: A thorough physical examination of the eyes, eyelids, and surrounding structures is performed to assess the signs and symptoms of dacryoadenitis. This may include checking for redness, swelling, and tenderness in the lacrimal gland area.
- Visual acuity test: This test evaluates the clarity and sharpness of the patient’s vision. It helps determine if the inflammation of the lacrimal gland is affecting vision or not.
- External eye examination: The external eye examination involves a close inspection of the eyelids, conjunctiva, and surrounding tissues to identify any visible signs of inflammation or infection.
- Slit-lamp examination: A slit-lamp examination is a specialized microscope that allows a detailed examination of the anterior segment of the eye. It helps in evaluating the lacrimal gland, eyelids, and conjunctiva for signs of inflammation or infection.
- Fundus examination: A fundus examination is performed to assess the back of the eye, including the retina, optic nerve, and blood vessels. It helps in ruling out other causes of eye symptoms and assessing the overall health of the eye.
- Blood tests: Blood tests may be ordered to identify the underlying cause of dacryoadenitis. These tests may include a complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and autoimmune markers like antinuclear antibodies (ANA).
- Microbiological cultures: If infection is suspected, a sample may be taken from the affected area and sent for microbiological culture. This helps identify the specific bacteria or viruses responsible for the infection.
- Biopsy: In some cases, a biopsy of the lacrimal gland may be necessary to obtain a tissue sample for further analysis. A biopsy can help confirm the diagnosis and rule out other conditions.
- Imaging studies: Imaging techniques such as ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) scan may be used to visualize the lacrimal gland and surrounding structures. These tests help identify any structural abnormalities or blockages.
- Schirmer’s test: Schirmer’s test measures the amount of tears produced by the lacrimal gland. A small strip of filter paper is placed in the lower eyelid, and the amount of wetting is measured after a specific time. A reduced tear production may indicate lacrimal gland dysfunction.
- Tear osmolarity test: Tear osmolarity test measures the salt content in the tears. Elevated tear osmolarity can be an indicator of lacrimal gland inflammation.
- Tear film breakup time (TBUT): TBUT test evaluates the stability of the tear film. It involves applying a special dye to the eye’s surface and observing how long it takes for the tear film to break up. A shorter TBUT may indicate inadequate tear production.
- Schirmer I test: Schirmer I test evaluates the basal tear secretion by placing a filter paper strip in the lower eyelid without anesthesia. The amount of wetting in a specific time indicates the baseline tear production.
- Meibography: Meibography is a specialized imaging technique that examines the structure of the meibomian glands. These glands play a crucial role in tear production, and their dysfunction can contribute to dacryoadenitis.
- Lacrimal scintigraphy: Lacrimal scintigraphy is a nuclear medicine test that evaluates the drainage of tears from the eyes. It helps identify any blockages or abnormalities in the lacrimal drainage system.
- Lacrimal gland biopsy: In certain cases, a biopsy of the lacrimal gland may be necessary to confirm the diagnosis and identify any specific underlying causes, such as lymphoma or sarcoidosis.
- Serological tests: Serological tests, including antibody tests and specific antigen tests, may be performed to identify the presence of infectious agents such as bacteria, viruses, or parasites.
- Allergy testing: Allergy testing may be conducted to determine if an allergic reaction is contributing to the inflammation of the lacrimal gland. This can involve skin prick tests or blood tests to detect specific allergens.
- Consultation with specialists: Depending on the underlying cause and severity of the dacryoadenitis, a consultation with specialists such as ophthalmologists, oculoplastic surgeons, rheumatologists, or infectious disease specialists may be required to guide further evaluation and management.
It is important to note that the specific diagnostic tests and procedures used for dacryoadenitis may vary depending on the individual patient’s presentation and the suspected underlying cause.
Treatments
The condition can be caused by various factors, including infection, autoimmune disorders, and blockage of the tear ducts. Treatment for dacryoadenitis aims to reduce inflammation, relieve symptoms, and address the underlying cause.
One study suggests that idiopathic dacryoadenitis may respond to surgical debulking, with a low relapse rate.[rx] Refractory cases of inflammatory dacryoadenitis may benefit from orbital radiotherapy, methotrexate, or rituximab. IgG4-related disease has a high rate of remission with rituximab, but this effect may be temporary.[rx]
Management of IgG4-related dacryoadenitis is still debated. An initial trial of corticosteroids is reasonable. Immunosuppression is only rarely necessary. There are reports suggesting that sclerosing dacryoadenitis that is associated with IgG4 can go on to develop lymphoma.[rx]
- Antibiotics: If the cause of dacryoadenitis is bacterial infection, antibiotics such as penicillin, cephalosporins, or fluoroquinolones may be prescribed to eliminate the infection.
- Warm compresses: Applying warm compresses to the affected area can help reduce inflammation, relieve pain, and promote healing. This can be done multiple times a day for around 10-15 minutes each time.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications like ibuprofen or naproxen can be used to reduce pain and inflammation associated with dacryoadenitis.
- Steroid eye drops: Topical steroid eye drops, such as prednisolone, can help decrease inflammation and provide relief from symptoms. These should be used under the guidance of a healthcare professional.
- Systemic steroids: In severe cases of dacryoadenitis, oral or intravenous steroids may be prescribed to control inflammation throughout the body.
- Pain relievers: Over-the-counter pain medications like acetaminophen or paracetamol can be used to alleviate discomfort and pain associated with dacryoadenitis.
- Artificial tears: Lubricating eye drops or ointments can help relieve dryness and soothe the eyes, which can be beneficial in cases where tear production is affected.
- Dilation and probing: If the tear ducts are blocked, a procedure called dilation and probing may be performed to open up the ducts and restore normal tear flow.
- Tear duct massage: Gentle massage along the tear ducts can help improve tear drainage and alleviate symptoms of dacryoadenitis.
- Moisture chamber glasses: These special glasses create a humid environment around the eyes, reducing dryness and providing relief from discomfort.
- Saline irrigation: A saline solution can be used to flush out the tear ducts and remove any debris or blockages contributing to dacryoadenitis.
- Surgical drainage: In some cases, a surgical procedure may be necessary to drain any abscesses or fluid buildup in the lacrimal gland.
- Complementary therapies: Techniques such as acupuncture or acupressure may be considered as adjunctive treatments to help manage pain and promote healing.
- Eyelid hygiene: Keeping the eyelids clean and free from debris can help prevent further infection and reduce symptoms of dacryoadenitis.
- Allergy management: If allergies are contributing to dacryoadenitis, allergy medications, such as antihistamines or corticosteroids, may be prescribed.
- Antiviral medications: If dacryoadenitis is caused by a viral infection, antiviral medications may be prescribed to target the specific virus.
- Immunomodulatory drugs: In cases where dacryoadenitis is associated with an autoimmune disorder, medications that modulate the immune system, such as methotrexate or cyclosporine, may be used.
- Management of underlying conditions: If dacryoadenitis is secondary to an underlying condition, such as sarcoidosis or thyroid eye disease, treating the underlying cause is essential.
- Drainage and irrigation: In severe cases of dacryoadenitis, a procedure known as dacryocystorhinostomy may be performed to create a new drainage pathway for tears.
- Cool compresses: In some instances, especially when there is significant swelling, applying cool compresses to the affected area may help reduce inflammation and provide relief.
- Avoiding irritants: Avoiding exposure to environmental irritants, such as smoke or allergens, can help minimize symptoms of dacryoadenitis.
- Nutrition and hydration: Consuming a balanced diet and staying adequately hydrated can support overall eye health and promote healing.
- Rest and relaxation: Adequate rest and stress management techniques can help boost the immune system and aid in the recovery process.
- Follow-up care: Regular follow-up visits with an ophthalmologist or eye specialist are crucial to monitor the progress of treatment and make any necessary adjustments.
- Imaging studies: In some cases, imaging studies like ultrasound or MRI may be performed to assess the extent of inflammation and aid in diagnosis.
- Culture and sensitivity testing: If infection is suspected, a culture and sensitivity test may be conducted to identify the specific pathogen causing dacryoadenitis and determine the most effective antibiotic.
- Physical therapy: In certain cases, physical therapy exercises, such as facial and eye muscle exercises, may be recommended to improve tear flow and reduce symptoms.
- Lifestyle modifications: Making lifestyle changes, such as quitting smoking or managing underlying conditions like diabetes, can contribute to overall eye health and aid in the treatment of dacryoadenitis.
- Supportive care: Adequate rest, a healthy diet, and proper self-care can support the body’s healing process and enhance the effectiveness of treatment.
- Surgical intervention: In rare cases where conservative treatments are ineffective, surgical removal of the lacrimal gland may be considered as a last resort.
It is important to note that the specific treatment plan for dacryoadenitis may vary depending on the underlying cause, severity of symptoms, and individual patient factors. Consulting with a healthcare professional is essential for an accurate diagnosis and appropriate treatment.
Medications
Dacryoadenitis is a condition characterized by inflammation of the lacrimal gland, which produces tears. The treatment of dacryoadenitis typically involves a combination of medications to reduce inflammation and manage the underlying cause. Here is a list of 20 drugs commonly used in the treatment of dacryoadenitis:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs like ibuprofen and naproxen sodium are often used to reduce pain and inflammation associated with dacryoadenitis.
- Corticosteroids: These anti-inflammatory medications, such as prednisone or dexamethasone, are frequently prescribed to reduce swelling and inflammation of the lacrimal gland.
- Antibiotics: If the inflammation is caused by a bacterial infection, antibiotics like amoxicillin, cephalexin, or doxycycline may be prescribed to treat the underlying infection.
- Antiviral drugs: In cases where dacryoadenitis is caused by a viral infection, antiviral medications like acyclovir or valacyclovir may be used to combat the virus.
- Topical corticosteroids: These medications are available in the form of eye drops or ointments and are used to reduce inflammation directly in the affected area.
- Artificial tears: Lubricating eye drops or ointments can help relieve dryness and discomfort associated with dacryoadenitis.
- Warm compresses: Applying warm compresses to the affected eye can help soothe inflammation and promote drainage of blocked tear ducts.
- Pain relievers: Over-the-counter pain medications such as acetaminophen or tramadol may be recommended to manage pain associated with dacryoadenitis.
- Immunosuppressive drugs: In cases of autoimmune dacryoadenitis, medications like methotrexate or azathioprine may be prescribed to suppress the immune system and reduce inflammation.
- Antihistamines: If the inflammation is caused by an allergic reaction, antihistamine medications like loratadine or cetirizine may be used to alleviate symptoms.
- Mast cell stabilizers: These medications, such as cromolyn sodium or nedocromil, help prevent the release of histamine and reduce allergic reactions.
- Mucolytics: Drugs like acetylcysteine or bromhexine may be prescribed to thin mucus and promote drainage of blocked tear ducts.
- Decongestants: In cases where dacryoadenitis is associated with nasal congestion, decongestant medications like pseudoephedrine or oxymetazoline can help relieve congestion and promote drainage.
- Analgesic eye drops: These medicated eye drops, containing ingredients like phenylephrine or tetrahydrozoline, can help alleviate eye pain and reduce redness.
- NSAID eye drops: Topical nonsteroidal anti-inflammatory eye drops, such as ketorolac or bromfenac, can be used to reduce inflammation and relieve pain.
- Antifungal drugs: If the inflammation is caused by a fungal infection, antifungal medications like fluconazole or amphotericin B may be prescribed.
- Immunomodulatory drugs: Medications like cyclosporine or tacrolimus, which modify the immune response, may be used in chronic cases of dacryoadenitis.
- Systemic immunosuppressants: In severe cases of autoimmune dacryoadenitis, drugs like methotrexate or cyclophosphamide may be prescribed to suppress the immune system.
- Antineoplastic drugs: In cases where dacryoadenitis is associated with a tumor or lymphoma, chemotherapy drugs like methotrexate or cyclophosphamide may be used.
- Surgical interventions: In some cases, surgical procedures such as lacrimal gland biopsy, drainage of abscesses, or excision of tumors may be necessary to treat dacryoadenitis.
It’s important to note that the specific treatment plan for dacryoadenitis should be determined by a healthcare professional based on the individual’s condition, underlying cause, and medical history. This list provides an overview of the medications commonly used in the treatment of dacryoadenitis, but it is not exhaustive, and the availability of certain drugs may vary based on geographical location and healthcare practices.
