Definition
Tears are essential for keeping the eye surface moist and free of irritants. They consist of several layers, with one produced by the tear or lacrimal glands. Dacryoadenitis refers to inflammation of the lacrimal glands, located in the upper region of each eye. This condition can arise due to viral or bacterial infections, as well as from non-infectious sources of inflammation.
Although dacryoadenitis is uncommon, estimates suggest it affects around 10,000 people. The condition is generally self-limiting, meaning it often resolves on its own. It does not appear to have a predisposition related to race, gender, or age. Acute dacryoadenitis usually has favorable outcomes, though chronic cases may depend on the underlying cause.
Causes
The inflammation associated with dacryoadenitis is often triggered by an infection, usually viral in nature, though bacteria, fungi, and parasites may also be involved. The Epstein-Barr virus is the most frequent cause, though other viruses, including adenovirus, varicella zoster, herpes simplex, rhinovirus, cytomegalovirus, and mumps, may also lead to dacryoadenitis less commonly.
Dacryoadenitis can be attributed to bacterial infections, with Staphylococcus aureus and Streptococcus species being common culprits. In regions where tuberculosis is prevalent, cases of dacryoadenitis due to tuberculosis have been reported. Additionally, Neisseria gonorrhoeae has occasionally been identified as a cause.
Besides infection, dacryoadenitis may also result from non-specific orbital inflammation, malignancies such as lymphoma, adenoid cystic carcinoma, and pleomorphic adenoma. Chronic dacryoadenitis is sometimes associated with immune conditions, including Thyroid Eye Disease and Sjögren's syndrome.
Risk Factors
Factors that increase susceptibility to dacryoadenitis include viral and bacterial infections, as well as autoimmune diseases like Sjögren's syndrome and sarcoidosis.
Symptoms
Acute dacryoadenitis symptoms may include:
- Swelling in the upper eyelid, which may feel red, warm, and painful
- Redness in the eye
- Eye discharge
- Tearing
- Swollen lymph nodes along the jawline
- Limited eye movement
- Systemic symptoms, including fever, respiratory infections, fatigue, and enlarged parotid glands
- Protrusion of the eyeballs
For chronic dacryoadenitis, symptoms may include:
- Mild upper eyelid swelling, without significant redness, pain, or warmth
- Movable enlarged glands in the upper eyelid
- Unaffected vision
- Enlarged lymph nodes in the neck
- Dryness in the eyes
Diagnosis
Diagnosis begins with the doctor inquiring about the symptoms, such as whether there is upper eyelid pain, swelling, the timeline of symptom onset, presence of fever, prior respiratory infections, and immune disease history. Physical examination includes checking for lumps, eye movement, visual acuity, and enlarged neck glands. Additional diagnostic tests might include a CT scan to assess eye muscle involvement. Recurrent cases may require an MRI. Laboratory tests, including a complete blood count (CBC), infection markers, and autoimmune tests like ANA, may be conducted. In atypical cases, a biopsy could be necessary.
Management
Medical Treatments
Treatment varies depending on symptom severity, including observation, symptomatic relief, or surgery. Acute viral dacryoadenitis is managed by alleviating symptoms, while bacterial dacryoadenitis is treated with broad-spectrum antibiotics. If unresponsive, drainage of a lacrimal gland abscess may be required. Recurrent dacryoadenitis may be managed with orbital radiation or systemic therapy.
Follow-up Treatments
Returning to the doctor is advised if visual acuity declines, eye movement is restricted, or color vision changes.
Surgery
Surgery is reserved for recurrent or severe cases. Histopathological examination can help distinguish between infection, inflammation, and tumor. Abscesses detected clinically or through imaging should be drained.
Home Care
For acute dacryoadenitis, warm compresses and pain relievers may provide relief.
Complications
The most common complications of dacryoadenitis arise from delayed diagnosis and treatment. Although dacryoadenitis may resolve on its own, complications can include ptosis (drooping of the upper eyelid), reduced tear production, and dry eyes. If left untreated, dry eye can lead to further corneal involvement, resulting in permanent visual impairment. Another possible complication is cellulitis, an infection surrounding the eye cavity.
In around 15% of patients, untreated dacryoadenitis can recur. Some lacrimal gland cancers may initially appear similar to common dacryoadenitis, leading to misdiagnosis. Therefore, individuals experiencing recurrent dacryoadenitis that does not improve with treatment should seek prompt medical attention.
Prevention
Vaccination can prevent mumps, one of the causes of dacryoadenitis. However, prevention strategies for other causes of dacryoadenitis remain unavailable.
When to See a Doctor?
It is advisable to consult a healthcare provider if dacryoadenitis recurs, visual acuity changes suddenly, eye movement causes pain, or if dacryoadenitis persists despite treatment.
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- dr Hanifa Rahma
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