Dacryoadenitis. It is the inflammation of the lacrimal gland, rarely bilateral, which may be due to infectious, inflammatory or autoimmune causes, or it may be idiopathic.
1 In children it usually has a viral etiology, most frequently attributed to
Epstein-barr virus and rarely to
Adenovirus.
2 Acute adenovirus infection seems the likely etiology in our patient.
Clinical manifestations of dacryoadenitis depend on whether the disease process is acute or chronic.
1,2,3 Acute dacryoadenitis usually presents with erythema and tenderness over the area of the lacrimal gland with associated enlargement of the gland and pain.
3,4 There may be suppurative discharge, conjunctival chemosis and swollen lymph nodes, usually cervical and preauricular.
3,4 Additional eye symptoms such as photophobia, tearing or a foreign body sensation may also occur. Fever and malaise may also occur.
3,4 On the other hand, chronic dacryoadenitis, frequently presents in a more indolent manner and it is associated with painless enlargement of the lateral eyelids over several months.
2,4,5
The diagnosis of dacryoadenitis is based on physical examination and a thorough eye examination.
2 A CT scan of the orbit may be helpful, and it may reveal diffuse enlargement of the lacrimal gland, with marked enhancement with contrast (not observed in chronic dacryoadenitis) as was seen in our patient.
1,3 A laboratory evaluation may be performed to assess the etiology of this disease.
2,3
Treatment and prognosis depend on the underlying etiology.
3,5 Viral dacryoadenitis, the most frequent, is usually self-limiting and only supportive measures are needed, like warm compresses and oral nonsteroidal anti-inflammatories.
5 If the etiology is unclear, which happened initially in our case, empirical antibiotics should be initiated with an oral penicillin derivative or a first-generation cephalosporin.
4,5 If the lacrimal gland enlargement does not subside after 2-4 weeks of treatment or if there is a high suspicion of malignancy, a lacrimal gland biopsy should be performed and the treatment and prognosis will depend on the underlying situation.
3,5| References : |
- Gao Y, Moonis G, Cunnane ME, Eisenberg RL. Lacrimal gland masses. AJR Am J Roentgenol. 2013; 201:W37181.
- Tirkey E, Chandravanshi SL, Jain S, Mishra V. Presumed Acute Adenoviral Dacryoadenitis Associated with Epidemic Keratoconjunctivitis: A Case Report. Nigerian Journal of Ophthalmology. 2014; 22:90-92.
- Patel R, Patel BC. Dacryoadenitis. StatPearls Publishing. 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535384/. Accessed on 11th June 2021
- American International Medical University. Dacryoadenitis: Symptoms, Causes, Diagnosis and Management. 2017 February 10 [cited 2021 June 1]. Available from: www.aimu.us/2017/02/10/dacryoadenitis-symptoms-causes-diagnosis-and-management/.
- Medscape. Dacryoadenitis. 2018 June 19 [cited 2021 June 1]. Available from: emedicine.medscape.com/article/1210342-overview.
|