Acute dacryoadenitis - External and Internal Eye
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Synopsis
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 malignancies include pleomorphic adenoma, lymphoma, melanoma, adenoid cystic carcinoma, and metastases; these very rarely present in an acute fashion.
- Ptosis
- Hordeolum and chalazion
- Exophthalmos
- Orbital / preseptal cellulitis
- Orbital dermoid
- Idiopathic orbital inflammatory syndrome (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.
- Thyroid eye disease
- 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
Last Updated:02/06/2020