Dacryoadenitis: Difference between revisions
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===Etiology=== | ===Etiology=== | ||
*Viral most common ([[mumps]], [[EBV]], [[HSV]], [[CMV]], echoviruses, [[ | *Viral most common ([[mumps]], [[EBV]], [[HSV]], [[CMV]], echoviruses, [[coxsackie virus]] A) | ||
*Bacterial | *Bacterial | ||
**[[S. Aureus]] and [[strep]] most common | **[[S. Aureus]] and [[strep]] most common | ||
| Line 18: | Line 18: | ||
*Rapid onset, hours to days | *Rapid onset, hours to days | ||
*Chronic form > 1 mo | *Chronic form > 1 mo | ||
**May be | **May be bilateral | ||
**May be painless | **May be painless | ||
**More common than acute form | **More common than acute form | ||
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***Fever, URI, malaise | ***Fever, URI, malaise | ||
***Parotid gland enlargement | ***Parotid gland enlargement | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Neonatal eye problems DDX}} | {{Neonatal eye problems DDX}} | ||
==Evaluation== | |||
*CT orbits with contrast if concern for [[orbital cellulitis]] | |||
*Bacterial culture, fungal if suspect | |||
==Management== | ==Management== | ||
*Warm compresses | *Warm compresses | ||
*NSAIDs | *[[NSAIDs]] | ||
*Based on etiology | *Based on etiology | ||
**Bacterial - cephalexin 500mg q6 until culture results | **Bacterial - [[cephalexin]] 500mg q6 until culture results | ||
***Add TMP-SMX (TMP 160mg q12hr) if concern for MRSA | ***Add [[TMP-SMX]] (TMP 160mg q12hr) if concern for MRSA | ||
**Protozoal or fungal - treat underlying infection | **Protozoal or fungal - treat underlying infection | ||
**Systemic, inflammatory/noninfectious - investigate underlying etiology | **Systemic, inflammatory/noninfectious - investigate underlying etiology | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Ophthalmology]] | [[Category:Ophthalmology]] | ||
Revision as of 16:39, 5 October 2019
Background
- Ascension of agent from conjunctiva into lacrimal glands
- Anatomy
- Two lobes: orbital and palpebral lobes
- Palpebral lobe visualized by everting eyes
- Uncommon, with 1/10,000 ophthalmic patients having dacryoadenitis
Etiology
- Viral most common (mumps, EBV, HSV, CMV, echoviruses, coxsackie virus A)
- Bacterial
- Fungal rare
- Inflammatory systemic (sarcoidosis, Graves' disease, Sjögren)
Clinical Features
- Unilateral pain, redness, swelling, pressure in orbital supratemporal area
- Rapid onset, hours to days
- Chronic form > 1 mo
- May be bilateral
- May be painless
- More common than acute form
- Physical exam
- Chemosis, conjunctival injection, mucopurulent discharge
- Propotosis
- Swelling of lateral third of upper lid (S-shaped lid)
- Systemic signs
- Fever, URI, malaise
- Parotid gland enlargement
Differential Diagnosis
- Lacrimal gland tumor
Periorbital swelling
Proptosis
- Normal IOP
- Orbital cellulitis
- Orbital pseudotumor
- Orbital tumor
- Increased IOP
- Retrobulbar abscess
- Retrobulbar emphysema
- Retrobulbar hemorrhage
- Ocular compartment syndrome
- Orbital tumor
No proptosis
- Periorbital cellulitis/erysipelas
- Dacryocystitis (lacrimal duct)
- Dacryocele/Dacryocystocele
- Dacryostenosis
- Dacryoadenitis (lacrimal gland)
- Allergic reaction
- Nephrotic Syndrome (pediatrics)
Lid Complications
- Blepharitis (crusts)
- Chalazion (meibomian gland)
- Stye (hordeolum) (eyelash folicle)
Other
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Conjunctivitis
- Contact dermatitis
- Herpes zoster
- Herpes simplex
- Sarcoidosis
- Granulomatosis with polyangiitis
Neonatal eye problems
- Nasolacrimal duct obstruction
- Dacrocystitis
- Conjunctivitis
- Chemical
- Gonococcal
- Chlamydia
- Herpetic
- Streptococcus/S. Aureus
- Early onset glaucoma
- Uveitis
- Ocular foreign body
- Corneal abrasion
- Ocular trauma
- Ingrown eyelash
Evaluation
- CT orbits with contrast if concern for orbital cellulitis
- Bacterial culture, fungal if suspect
Management
- Warm compresses
- NSAIDs
- Based on etiology
- Bacterial - cephalexin 500mg q6 until culture results
- Add TMP-SMX (TMP 160mg q12hr) if concern for MRSA
- Protozoal or fungal - treat underlying infection
- Systemic, inflammatory/noninfectious - investigate underlying etiology
- Bacterial - cephalexin 500mg q6 until culture results
Disposition
- Outpatient ophtho referral