Dacryoadenitis - Case Discussion

This young patient is referred to the ophthalmologist with the presenting complains of unilateral upper eyelid swelling and tenderness.

The case of diagnosed as Dacryoadenitis.

Case Discussion :
Dacryoadenitis is the inflammation of the lacrimal glands

Acute dacryoadenitis typically involves children and young adults with associated systemic infections such as gonorrhea, mumps, Epstein-Barr virus, and Staphlyococcus species.

Clinical Findings are localized to the outer one-third of the upper eyelid and include fullness or swelling, erythema, and tenderness.
A characteristic “S”-shaped deformity with ptosis of the lid may be seen.
In more advanced cases proptosis, inferonasal globe displacement, ophthalmoparesis, and diplopia may be present.

Chronic dacryoadenitis is more common, is seen in older patients, and is usually due to tumor or associated inflammatory disorders such as sarcoidosis, Sjögren syndrome, or IgG4-related diseases.


Important Learning Points: 
1. Swelling is localized over the lateral one-third of the upper lid and imparts an “S”-shaped curve to the lid margin.
2. Acute dacryoadenitis is usually seen as a complication of mumps, with (bilateral) parotid swelling.
3. Chronic dacryoadenitis is more common, and is seen in older patients. Malignancy should be considered.
4. IgG4-related disease should be considered in patients (particularly middle-aged and older men) with bilateral disease and either salivary gland enlargement or pancreatitis
of unknown origin.
5. Urgent referral is recommended for patients with diplopia, limitation of the extraocular muscles, or reduction of vision.

Management: 

• For acute dacryoadenitis, amoxicillin-clavulanate or IV ampicillin-sulbactam are used, depending on the severity and patient’s toxicity. 
• In cases of dacryoadenitis due to mumps or Epstein-Barr virus, warm compresses are recommended.
• Resolution occurs spontaneously. 
• Patients should return to the ED for symptoms suggestive of orbital cellulitis such as decreased ocular motility or proptosis.
• Treatment of chronic dacryoadenitis involves treatment of the underlying disorder.
• Nonemergent ophthalmology follow-up is appropriate.