Dacryadenitis

Dacryadenitis, also called dacryoadenitis, is inflammation of the lacrimal gland, which is located in the superolateral aspect of the orbit. It typically presents with swelling of the outer upper eyelid, often accompanied by tenderness, fever, and discomfort. The swelling is usually unilateral, though viral infections can cause bilateral involvement. Eye tearing and mild redness may be present, and in some cases there is associated eye pain or limited eye movement if the orbit is affected.

Etiology and classification: Acute dacryoadenitis is most often infectious, with viral causes such as mumps, adenovirus, or Epstein-Barr virus, and bacterial causes including Staphylococcus aureus and Streptococcus species. Chronic dacryoadenitis is less common and may reflect underlying systemic inflammatory or autoimmune diseases (eg, sarcoidosis, Sjögren syndrome, rheumatoid arthritis), orbital lymphoproliferative disorders, or, less commonly, chronic infections or neoplasia. Distinction from dacryocystitis (inflammation of the lacrimal sac) is important.

Diagnosis: Diagnosis is clinical, based on history and exam. Imaging (ultrasound, CT, or MRI) is used when orbital involvement, a mass, or complications are suspected, or to assess the lacrimal gland if the diagnosis is uncertain. Laboratory tests may be undertaken to evaluate systemic causes if indicated.

Treatment: Acute viral dacryoadenitis is usually managed with supportive care—cold compresses, analgesics, and artificial tears. Bacterial dacryoadenitis requires antibiotics that cover Staphylococcus species (eg, dicloxacillin or cephalexin; alternatives include clindamycin or TMP-SMX for MRSA risk). Severe cases or abscess formation may require hospitalization or drainage and intravenous antibiotics. Chronic dacryoadenitis is treated by addressing the underlying disease; corticosteroids may be considered in certain inflammatory conditions after evaluation.

Prognosis: With appropriate management, many cases improve, though chronic forms may require ongoing evaluation for associated systemic diseases. See also dacryocystitis and lacrimal gland disorders.