Dacryoadenitis

Dacryoadenitis denotes inflammation of the lacrimal gland, which sits in the lacrimal fossa at the upper outer orbit. It typically presents with swelling of the upper eyelid in the lateral region of the orbit and tenderness over the lacrimal gland, sometimes accompanied by mild eye pain and tearing.

Dacryoadenitis can be acute or chronic and may arise from infectious, inflammatory, or less commonly neoplastic processes. Acute dacryoadenitis is most often infectious, with viral etiologies such as mumps and adenovirus and bacterial organisms including Staphylococcus aureus and Streptococcus species. Noninfectious causes include autoimmune inflammatory diseases such as sarcoidosis, Sjögren’s syndrome, and IgG4-related disease. Chronic dacryoadenitis usually reflects an inflammatory or autoimmune process or, less commonly, a chronic infection.

Clinical features of acute disease include abrupt lacrimal gland swelling in the superotemporal orbit, marked tenderness, eyelid edema, fever, malaise, tearing, and sometimes diplopia if adjacent extraocular muscles are affected. Chronic disease tends to be a painless, persistent swelling that may be accompanied by tearing.

Diagnosis is clinical, supported by imaging if orbital involvement is suspected. CT or MRI can show lacrimal gland enlargement and help exclude abscess or orbital cellulitis. Laboratory tests—complete blood count with differential, inflammatory markers, and cultures of any purulent discharge—aid in determining etiology; serologic testing for autoimmune disease may be indicated based on history.

Treatment depends on cause. Acute bacterial disease is treated with appropriate systemic antibiotics; viral cases are managed supportively with analgesia and local measures. Autoimmune or IgG4-related dacryoadenitis may require corticosteroids or other immunosuppressants. Abscess or orbital involvement requires prompt drainage and hospital care.

Prognosis is generally good with timely therapy, but delays can lead to orbital cellulitis, abscess, or vision disturbance.