Laboratory Studies
Acute dacryoadenitis
The following laboratory studies may be used in the workup of acute dacryoadenitis (dependent on clinical presentation):
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Smear and culture if purulent discharge is noted.
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Blood cultures to rule out N gonorrhoeae infections
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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.
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
