Dacryoadenitis

Specialty: Ophthalmology.

• inflammation of the tear gland
• S-shaped swollen upper eyelid
• acute dacryoadenitis

Why it occurs

• Systemic or localized viral infection (mumps virus, Epstein-Barr virus, influenza)
• Acute suppurative bacterial infection of the gland (commonly due to Staphylococcus aureus or Streptococcus species)
• Systemic non-infectious inflammatory disease (Sarcoidosis, Granulomatosis with polyangiitis)
• IgG4-related disease (very common cause of chronic dacryoadenitis with a bilateral painless course)
• Idiopathic inflammatory orbital pseudotumor limited to the lacrimal gland

Initial workup

Physical eyelid examination identifying the typical eyelid deformity in the shape of a "lying S or italic" shape; Computed Tomography (CT) of the orbits with intravenous contrast (to evaluate glandular size, rule out erosion of the orbital bone fossa or formation of lobulated abscesses); Biopsy of the lacrimal gland (strictly indicated in chronic, bilateral cases or with incomplete response to steroids to differentiate sarcoidosis, IgG4 disease or lacrimal gland lymphoma); General analysis with serum levels of IgG4 and ACE.

Standard management

• Amoxicillin with Clavulanic Acid — 875/125 mg orally every 8 hours for 7 to 10 days if acute uncomplicated bacterial etiology is suspected
• Prednisone — orally, 1 mg/kg/day with a subsequent gradual decrease regimen in dacryoadenitis of idiopathic inflammatory or immunological origin or IgG4 disease
• Paracetamol (500 mg to 1000 mg orally every 8 hours as a supportive systemic analgesic).