Dacryoadenitis: Difference between revisions
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===Etiology=== | ===Etiology=== | ||
*Viral most common (mumps, EBV, HSV, CMV, echoviruses, coxsackievirus A) | *Viral most common ([[mumps]], [[EBV]], [[HSV]], [[CMV]], echoviruses, [[coxsackievirus]] A) | ||
*Bacterial | *Bacterial | ||
**S. | **[[S. Aureus]] and [[strep]] most common | ||
**GC, | **[[GC]], [[syphilis]], [[chlamydia]], [[TB]], mycobacterium leprae ([[leprosy]]), [[borrelia burgdorferi]] | ||
*Fungal rare | *Fungal rare | ||
*Inflammatory systemic ( | *Inflammatory systemic ([[sarcoidosis]], [[Graves' disease]], [[Sjögren]]) | ||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 07:35, 17 August 2017
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, coxsackievirus 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 b/l
- 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
Evaluation
- CT with contrast if concern for orbital cellulitis
- Bacterial culture, fungal if suspect
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
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
References
- Singh GJ et al. Dacryoadenitis. eMedicine. March 2015. http://emedicine.medscape.com/article/1210342-overview#showall.