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Acute dacryoadenitis - External and Internal Eye
Other Resources UpToDate PubMed

Acute dacryoadenitis - External and Internal Eye

Contributors: Sid Schechet MD, D. Chimene Richa MD, Lauren Patty Daskivich MD, MSHS
Other Resources UpToDate PubMed

Synopsis

Acute dacryoadenitis is inflammation of the lacrimal gland, which typically causes pain, edema, and erythema in the superotemporal portion of the orbit and surrounding tissues. It is more common in children and young adults but can present at any age.

While dacryoadenitis can present in many ways, the timing of onset is helpful in making management decisions. Acute dacryoadenitis presents in hours to days and is typically quite severe and painful. Chronic dacryoadenitis often presents in a more indolent manner over months to years, and the glands may feel less painful and more irregular than in acute settings. Dacryoadenitis can occur unilaterally or bilaterally.

There are many etiologies of dacryoadenitis, but the two broad categories are infectious and inflammatory reactions. Infectious causes, including bacterial, viral, fungal, and parasitic, tend to cause acute dacryoadenitis. Viral is the most common etiology with Epstein-Barr virus (EBV) being the most common source. Other viruses include cytomegalovirus (CMV), herpes simplex (HSV), influenza, and varicella zoster (VZV). Mumps used to be a common cause of bilateral dacryoadenitis, but the incidence has dramatically decreased due to immunizations.

Inflammatory etiologies, typically more common than infectious, include sarcoidosis, polyangiitis with granulomatosis, thyroid disease, Sjögren syndrome, inflammatory bowel disease, and idiopathic orbital inflammation.

Prognosis for acute dacryoadenitis is generally good but ultimately depends on the state of the underlying systemic disease.

Codes

ICD10CM:
H04.019 – Acute dacryoadenitis, unspecified lacrimal gland

SNOMEDCT:
2589008 – Acute dacryoadenitis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Malignancy – Can mimic indolent, chronic dacryoadenitis. Possible Lacrimal gland tumor include Benign salivary gland tumor, Lymphoma, Melanoma, Adenoid cystic carcinoma of ear, and Metastatic tumors to the orbit; these very rarely present in an acute fashion.
  • Blepharoptosis
  • Hordeolum and chalazion
  • Proptosis
  • Orbital cellulitis / Preseptal cellulitis
  • Cutaneous dermoid cyst
  • Nonspecific orbital inflammation (orbital pseudotumor) – Diagnosis of exclusion. Orbital pseudotumor presents acutely, is extremely painful, and is very responsive to corticosteroid therapy, which is a hallmark of this disease.
  • Graves ophthalmopathy
  • Blepharochalasis
  • Mikulicz disease – This rare, chronic, benign condition is self-limited and causes symmetric enlargement of the lacrimal, submandibular, and parotid glands. This is thought to be an autoimmune condition where the lacrimal glands are infiltrated with lymphocytes.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:08/19/2019
Last Updated:02/06/2020
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Acute dacryoadenitis - External and Internal Eye
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A medical illustration showing key findings of Acute dacryoadenitis : Eye pain, Erythema, Eyelid edema, Lacrimal gland enlarged, Excessive tearing
Copyright © 2024 VisualDx®. All rights reserved.