eMedicine Specialties > Ophthalmology > Lacrimal System

Dacryoadenitis: Differential Diagnoses & Workup

Author: Gagan J Singh, MD, Chief of Ophthalmology, GMS Medical Eye Center, LLC
Coauthor(s): Richard Ahuja, MD, Clinical Instructor, Department of Ophthalmology, University of Maryland Medical School
Contributor Information and Disclosures

Updated: Mar 19, 2009

Differential Diagnoses

Cellulitis, Orbital
Exophthalmos
Cellulitis, Preseptal
Hordeolum
Chalazion
Lacrimal Gland Tumors
Dermoid, Orbital
Ptosis, Adult
Dry Eye Syndrome

Workup

Laboratory Studies

  • Acute dacryoadenitis (dependent on clinical presentation)
    • Smear and culture if purulent discharge is noted.
    • Blood cultures to rule out N gonorrhoeae infections
    • Immunoglobulin titers to specific virus; not usually indicated (see Causes) 
  • Chronic dacryoadenitis
    • Usually seen with chronic systemic conditions (eg, sarcoidosis, Sjögren syndrome, Graves disease). Seek advice from the patient's internist. Lacrimal gland biopsy may provide helpful information.
    • Rule out infectious causes (rare). They include syphilis, leprosy, tuberculosis, and trachoma. 

Imaging Studies

  • Acute dacryoadenitis
    • CT scan of the orbits with contrast can be helpful. The affected lacrimal gland shows diffuse enlargement, oblong shape, and marked enhancement with contrast.
    • No compressive changes in the contiguous bone or globe are noted.
  • Chronic dacryoadenitis
    • CT scan of the orbits with contrast show similar findings when compared to acute dacryoadenitis, except that chronic lesions show no marked enhancement with contrast. In addition, the lacrimal gland changes may be bilateral in contrast to acute dacryoadenitis.
    • Again, no compressive changes in the contiguous bone or globe are noted. If these changes are noted, then consider lacrimal gland tumors.

Histologic Findings

Lacrimal gland biopsy results vary depending upon the etiology. Biopsy is not indicated in acute dacryoadenitis.

Sarcoidosis - Noncaseating granulomatous tubercles, lymphocytic infiltration, and replacement of secretory acini by fibrous tissue

Graves disease - Lymphocytic infiltrate with edematous fibrous tissue and glandular degeneration

Sjögren syndrome - Lymphocytes and plasma cells infiltration

More on Dacryoadenitis

Overview: Dacryoadenitis
Differential Diagnoses & Workup: Dacryoadenitis
Treatment & Medication: Dacryoadenitis
Follow-up: Dacryoadenitis
References
[ CLOSE WINDOW ]

References

  1. Kubal A, Garibaldi DC. Dacryoadenitis caused by methicillin-resistant Staphylococcus aureus. Ophthal Plast Reconstr Surg. Jan-Feb 2008;24(1):50-1. [Medline].

  2. Nieto JC, Kim N, Lucarelli MJ. Dacryoadenitis and orbital myositis associated with lyme disease. Arch Ophthalmol. Aug 2008;126(8):1165-6. [Medline].

  3. Kamao T, Miyazaki T, Soga Y, et al. Genetic dissociation of dacryoadenitis and sialadenitis in a Sjogren's syndrome mouse model with common and different susceptibility gene loci. Invest Ophthalmol Vis Sci. Feb 14 2009;[Medline].

  4. Boruchoff SA, Boruchoff SE. Infections of the lacrimal system. Infect Dis Clin North Am. Dec 1992;6(4):925-32. [Medline].

  5. Brindley GO. Dacryoadenitis. In: Oculoplastic and Orbital Emergencies. Appleton & Lange: 1990:45-50.

  6. Fitzsimmons TD, Wilson SE, Kennedy RH. Infectious dacryoadenitis. In: Ocular Infection and Immunity. St Louis, Mo: Mosby; 1996:1341-45.

  7. Jakobiec FA, Yeo JH, Trokel SL, et al. Combined clinical and computed tomographic diagnosis of primary lacrimal fossa lesions. Am J Ophthalmol. Dec 1982;94(6):785-807. [Medline].

  8. Massaro BM, Tabbara KF. Infections of lacrimal apparatus. In: Infections of the Eye. Boston: Little Brown; 1996:551-8.

  9. Podos SM, Yanoff M. Acute dacryoadenitis. In: Textbook of Ophthalmology - External Disease. Europe: Mosby-Year Book; 1994:1414-6.

  10. Rhem MN, Wilhelmus KR, Jones DB. Epstein-Barr virus dacryoadenitis. Am J Ophthalmol. Mar 2000;129(3):372-5. [Medline].

  11. Tomita M, Shimmura S, Tsubota K, Shimazaki J. Dacryoadenitis associated with Acanthamoeba keratitis. Arch Ophthalmol. Sep 2006;124(9):1239-42. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

dacryoadenitis, acute dacryoadenitis, chronic dacryoadenitis, lacrimal gland, lacrimal gland inflammation, inflammation of lacrimal gland, inflammatory enlargement of lacrimal gland, lacrimal gland tumors

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Gagan J Singh, MD, Chief of Ophthalmology, GMS Medical Eye Center, LLC
Gagan J Singh, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, and American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Richard Ahuja, MD, Clinical Instructor, Department of Ophthalmology, University of Maryland Medical School
Richard Ahuja, MD is a member of the following medical societies: American Academy of Ophthalmology and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Ron W Pelton, MD, PhD, Private Practice, Colorado Springs, Colorado
Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society, Utah Medical Association, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching; Ortho-Neutrogenia Consulting fee Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

RELATED EMEDICINE ARTICLES
RELATED MEDSCAPE ARTICLES
Articles
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.