Difference between revisions of "Dacryoadenitis"

(Created page with "==Background== *Ascension of agent from conjunctiva into lacrimal glands *Anatomythumbnail **Two lobes: orbital and palpebral lobes **...")
 
(Management)
 
(12 intermediate revisions by 6 users not shown)
Line 6: Line 6:
 
*Uncommon, with 1/10,000 ophthalmic patients having dacryoadenitis
 
*Uncommon, with 1/10,000 ophthalmic patients having dacryoadenitis
  
==Etiology==
+
===Etiology===
*Viral most common (mumps, EBV, HSV, CMV, echoviruses, coxsackievirus A)
+
*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
**GC, syphilitic, chlamydia, TB, mycobacterium leprae, borrelia burgdorferi
+
**[[GC]], [[syphilis]], [[chlamydia]], [[TB]], mycobacterium leprae ([[leprosy]]), [[borrelia burgdorferi]]
 
*Fungal rare
 
*Fungal rare
*Inflammatory systemic (sarcoid, Graves, Sjogren)
+
*Inflammatory systemic ([[sarcoidosis]], [[Graves' disease]], [[Sjögren]])
  
 
==Clinical Features==
 
==Clinical Features==
Line 18: Line 18:
 
*Rapid onset, hours to days
 
*Rapid onset, hours to days
 
*Chronic form > 1 mo
 
*Chronic form > 1 mo
**May be b/l
+
**May be bilateral
 
**May be painless
 
**May be painless
 
**More common than acute form
 
**More common than acute form
 
*Physical exam
 
*Physical exam
**Chemosis, conjunctival injection, mucopurulent d/c
+
**Chemosis, conjunctival injection, mucopurulent discharge
 
**Propotosis
 
**Propotosis
 
**Swelling of lateral third of upper lid (S-shaped lid)
 
**Swelling of lateral third of upper lid (S-shaped lid)
Line 29: Line 29:
 
***Parotid gland enlargement
 
***Parotid gland enlargement
  
==Diagnosis==
+
==Differential Diagnosis==
*CT with contrast if concern for [[orbital cellulitis]]
 
*Bacterial culture, fungal if suspect
 
 
 
==Differential==
 
 
*Lacrimal gland tumor
 
*Lacrimal gland tumor
 
{{Periorbital swelling DDX}}
 
{{Periorbital swelling DDX}}
  
 
{{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 500 mg q6 until culture results
+
**Bacterial - [[cephalexin]] 500mg q6 until culture results
***Add TMP-SMX (TMP 160 mg 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
  
==Dispo==
+
==Disposition==
*Outpt ophtho referral
+
*Outpatient ophtho referral
  
==Sources==
+
==References==
 
<references/>
 
<references/>
*Singh GJ et al. Dacryoadenitis. eMedicine. March 2015. http://emedicine.medscape.com/article/1210342-overview#showall.
+
 
  
 
[[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