eMedicine Specialties > Ophthalmology > Lacrimal System

Dacryoadenitis: Treatment & Medication

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

Treatment

Medical Care

The treatment of dacryoadenitis varies with onset and etiology.

  • Acute dacryoadenitis
    • Viral (most common) - Self-limiting, supportive measures (eg, warm compresses, oral nonsteroidal anti-inflammatories)
    • Bacterial - Initiate with first-generation cephalosporins (eg, Keflex 500 mg qid) until culture results are obtained.
    • Protozoan or fungal related - Treat the underlying infection accordingly with specific antiamoebic or antifungal agents.
    • Inflammatory (noninfectious) - Investigate for systemic etiology, and treat accordingly.
  • Chronic dacryoadenitis
    • In most cases, treat the underlying systemic condition.
    • If the enlargement does not subside after 2 weeks, consider lacrimal gland biopsy.

Consultations

When considering sarcoidosis, tuberculosis (TB), Sjögren syndrome, or Graves disease as the etiology, consultation with an internist is important.

Medication

Gram-positive organisms are the most common cause of acute bacterial dacryoadenitis. Therefore, initiating coverage for these organisms is important prior to obtaining culture results. Cephalexin (Keflex) is an excellent choice. If the patient needs to be hospitalized because of the severity of illness, then use IV cefazolin (Ancef).

Antibiotics

Used for suspected bacterial infections.


Cephalexin (Keflex)

Provides excellent broad-spectrum coverage for both gram-positive and gram-negative organisms associated with dacryoadenitis.

Adult

1-4 g/d PO in divided doses

Pediatric

Not established
Recommended dose: 25-50 mg/kg/d PO divided qid

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Follow carefully for allergic reaction


Cefazolin (Ancef)

First choice in IV medication for dacryoadenitis. Provides excellent broad-spectrum coverage for both gram-positive and gram-negative organisms associated with dacryoadenitis.

Adult

1 g IV q8h

Pediatric

<1 month: Not established
>1 month: 50-100 mg/kg/d IV divided tid

Probenecid may decrease renal tubular secretion of cefazolin when used concurrently, resulting in increased and more prolonged cefazolin blood level

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Monitor for allergic reaction

More on Dacryoadenitis

Overview: Dacryoadenitis
Differential Diagnoses & Workup: Dacryoadenitis
Treatment & Medication: Dacryoadenitis
Follow-up: Dacryoadenitis
References
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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].

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Further Reading

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Keywords

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

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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.

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