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Dacryoadenitis Workup

  • Author: Gagan J Singh, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Mar 09, 2015
 

Laboratory Studies

Acute dacryoadenitis

The following laboratory studies may be used in the workup of 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

Chronic dacryoadenitis is 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.

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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.

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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

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Contributor Information and Disclosures
Author

Gagan J Singh, MD Chief of Ophthalmology, GMS Medical Eye Center, LLC; Clinical Assistant Professor, Department of Ophthalmology, West Virginia University School of Medicine

Gagan J Singh, MD is a member of the following medical societies: Alpha Omega Alpha, American Society of Cataract and Refractive Surgery, American Academy of Ophthalmology

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, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

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 College of Surgeons, AO Foundation, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society

Disclosure: Nothing to disclose.

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

  2. Nieto JC, Kim N, Lucarelli MJ. Dacryoadenitis and orbital myositis associated with lyme disease. Arch Ophthalmol. 2008 Aug. 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. 2009 Feb 14. [Medline].

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

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

  6. Fitzsimmons TD, Wilson SE, Kennedy RH. Infectious dacryoadenitis. 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. 1982 Dec. 94(6):785-807. [Medline].

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

  9. Podos SM, Yanoff M. Acute dacryoadenitis. 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. 2000 Mar. 129(3):372-5. [Medline].

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

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