Dacryoadenitis Clinical Presentation

Acute dacryoadenitis is characterized by the following:

• Unilateral, severe pain, redness, and pressure in the supratemporal region of the orbit

• Rapid onset (hours to days)

Chronic dacryoadenitis is characterized by the following:

• Can be bilateral, painless enlargement of the lacrimal gland present for more than a month

• More common than acute dacryoadenitis

Acute dacryoadenitis

The palpebral lobe of the lacrimal gland is often involved and is easily seen by everting the upper lid. It is noted to be prolapsed and enlarged. The palpebral lobe tends to be firm and tender upon palpation through the lid.

Other associated ophthalmic physical signs of acute dacryoadenitis include the following:

• Chemosis (conjunctival swelling)

• Conjunctival injection

• Mucopurulent discharge

• Erythema of eyelids

• Lymphadenopathy (submandibular)

• Swelling of the lateral third of the upper lid (S-shaped lid)

• Proptosis

• Ocular motility restriction

• Globe displacement inferiorly and medially

• Increased severity of signs and symptoms with orbital lobe involvement

• Acanthamoeba keratitis associated (rarely)

Systemic physical signs of acute dacryoadenitis include the following:

• Parotid gland enlargement

• Fever

• Upper respiratory infection

• Malaise

Chronic dacryoadenitis

Findings of chronic dacryoadenitis may include the following:

• Less severe presentation than acute dacryoadenitis

• No pain (usually)

• Enlarged gland but mobile

• Minimal ocular signs

• Mild ptosis secondary to enlargement of the gland (possible)

• Mild-to-severe dry eyes

Infectious dacryoadenitis

Causes of viral dacryoadenitis (most common) include the following:

• Mumps (most common, especially in childhood)

• Epstein-Barr virus

• Herpes zoster

• Mononucleosis

• Cytomegalovirus

• Echoviruses

• Coxsackievirus A

Causes of bacterial dacryoadenitis include the following:

• Staphylococcus aureus ^[1] and Streptococcus

• Neisseria gonorrhoeae

• Treponema pallidum

• Chlamydia trachomatis

• Mycobacterium leprae

• Mycobacterium tuberculosis

• Borrelia burgdorferi ^[2]

Causes of fungal dacryoadenitis (rare) include the following:

• Histoplasmosis

• Blastomycosis

• Parasite (rare)

• Schistosoma haematobium

• Protozoa (rare)

• Acanthamoeba keratitis associated

Inflammatory dacryoadenitis

Causes of inflammatory dacryoadenitis include the following:

• Sarcoidosis

• Graves disease

• Sjögren syndrome ^[3]

• Orbital inflammatory syndrome

• Benign lymphoepithelial lesion