Difference between revisions of "Dacryoadenitis"

(Background)
(Management)
 
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===Etiology===
 
===Etiology===
*Viral most common ([[mumps]], [[EBV]], [[HSV]], [[CMV]], echoviruses, [[coxsackievirus]] A)
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*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
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*Rapid onset, hours to days
 
*Rapid onset, hours to days
 
*Chronic form > 1 mo
 
*Chronic form > 1 mo
**May be b/l
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**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
 
==Evaluation==
 
*CT with contrast if concern for [[orbital cellulitis]]
 
*Bacterial culture, fungal if suspect
 
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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{{Neonatal eye problems DDX}}
 
{{Neonatal eye problems DDX}}
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 +
==Evaluation==
 +
*CT orbits with contrast if concern for [[orbital cellulitis]]
 +
*Bacterial culture, fungal if suspect
  
 
==Management==
 
==Management==
 
*Warm compresses
 
*Warm compresses
*NSAIDs
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*[[NSAIDs]]
 
*Based on etiology
 
*Based on etiology
**Bacterial - cephalexin 500mg q6 until culture results
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**Bacterial - [[cephalexin]] 500mg q6 until culture results
***Add TMP-SMX (TMP 160mg q12hr) if concern for MRSA
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***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/>
*Singh GJ et al. Dacryoadenitis. eMedicine. March 2015. http://emedicine.medscape.com/article/1210342-overview#showall.
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[[Category:ID]]
 
[[Category:ID]]
 
[[Category:Ophthalmology]]
 
[[Category:Ophthalmology]]

Latest revision as of 16:39, 5 October 2019

Background

  • Ascension of agent from conjunctiva into lacrimal glands
  • Anatomy
    Orbital and palpebral lobes.JPG
    • Two lobes: orbital and palpebral lobes
    • Palpebral lobe visualized by everting eyes
  • Uncommon, with 1/10,000 ophthalmic patients having dacryoadenitis

Etiology

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

No proptosis

Lid Complications

Other

Neonatal eye problems

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

Disposition

  • Outpatient ophtho referral

References