Dacryoadenitis: Difference between revisions

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==Background==
==Background==
[[File:Tear system.png|thumb|Lacrimal system consisting of: of lacrimal gland (a), punctums (b,e), canalicules (c,f), lacrimal sac (g,d).]]
[[File:orbital and palpebral lobes.JPG|thumbnail|Lateral view of lacrimal anatamy.]]
*Ascension of agent from conjunctiva into lacrimal glands
*Ascension of agent from conjunctiva into lacrimal glands
*Anatomy[[File:orbital and palpebral lobes.JPG|thumbnail]]
*Anatomy
**Two lobes: orbital and palpebral lobes
**Two lobes: orbital and palpebral lobes
**Palpebral lobe visualized by everting eyes
**Palpebral lobe visualized by everting eyes
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===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==
[[File:PMC3299166 JETS-5-92-g001.png|thumb|Bilateral dacryoadenitis: erythema and edema are greatest over the lateral one-third of the upper eyelids]]
[[File:PMC3299166 JETS-5-92-g002.png|thumb|Chemosis and injection of the sclera]]
*Unilateral pain, redness, swelling, pressure in orbital supratemporal area
*Unilateral pain, redness, swelling, pressure in orbital supratemporal area
*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
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***Fever, URI, malaise
***Fever, URI, malaise
***Parotid gland enlargement
***Parotid gland enlargement
==Diagnosis==
*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}}
==Evaluation==
[[File:PMC3299166 JETS-5-92-g004.png|thumb|Bilateral dacryoadenitis]]
*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/>
*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 21:38, 26 September 2020

Background

Lacrimal system consisting of: of lacrimal gland (a), punctums (b,e), canalicules (c,f), lacrimal sac (g,d).
Lateral view of lacrimal anatamy.
  • 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

Clinical Features

Bilateral dacryoadenitis: erythema and edema are greatest over the lateral one-third of the upper eyelids
Chemosis and injection of the sclera
  • 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

Bilateral dacryoadenitis
  • 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