Dacryoadenitis

Question 1

What is dacryodenitis?

Answer 1

• Inflammatory enlargement of lacrimal gland
• acute or chronic
• infectious or systemic etiology

Question 2

Describe chronic dacryoadenitis

bilateral?, painless? ocular signs?

Answer 2

• can be bilateral, painless enlargement of lacrimal gland
• enlarged mobile gland
• minimal ocular signs
• mild ptosis secondary to gland enlargement
• severe dry eye

Question 3

You have a patient that presents with inflammatory enlargement of the lacrimal gland. The gland is mobile and painless but the patient complains of dry eye. One week later, you see the gland enlarge causing a mild ptosis. What is the diagnosis?

A. Chronic dacryoadenitis
B. Acute dacryoadenitis

Answer 3

A. Chronic dacryoadenitis

Question 4

Describe ocular signs of acute dacryoadenitis

Answer 4

• unilateral
• severe pain
• redness (erythema) and swelling over outer 1/3 of upper eyelid
• proptosis, oculomotor restriction
• globe displaced inferior and medially
• rapid onset

Question 5

Describe systemic signs of acute dacryoadenitis

Answer 5

• parotid gland enlargement
• fever (if feverish, give complete blood count)
• upper respiratory infection
• malaise

Question 6

What is the most common cause of dacryoadenitis?

A. Viral
B. Bacterial
C. Fungal
D. Inflammatory

Answer 6

A. Viral

Mumps is most common

Question 7

What do Lab studies rule out for acute and chronic dacryoadenitis?

Answer 7

• Acute: blood cultures rule out gonorrhoeae
• Chronic: usually seen with chronic systemic conditions
• Rule out infectious causes: syphilis, leprosy, tuberculosis and trachoma

Question 8

Compare Imaging studies difference between acute and chronic dacryoadenitis

Answer 8

• Acute: no compressive changes seen in bone or globe
• Chronic: chronic lesions show no marked enhancement with contrast
• any compressive changes may indicate a lacrimal gland tumor

Question 9

Describe the different treatments for dacryoadenitis. (Viral, bacterial/infectious, Inflammatory, chronic)

Answer 9

• Viral (most common) - cool compresses, analgesic and daily follow up
• Bacterial/Infectious: mild - Keflex, moderate to severe: hospitalize
• Inflammatory: Investigate systemic etiology
• Chronic: treat systemic cause. Consider lacrimal gland biopsy, consult with internist.

Question 10

What is the treatment for viral dacryoadenitis?

A. cool compresses, analgesic and daily follow ups
B. Keflex or hospitalize if condition becomes severe
C. Treat underlying symptoms and lacrimal gland biopsy. Consult with internist if necessary.

Answer 10

A. cool compresses, analgesic and daily follow ups

Question 11

What is the treatment for bacterial/infectious dacryoadenitis?

A. cool compresses, analgesic and daily follow ups
B. Keflex or hospitalize if condition becomes severe
C. Treat underlying symptoms and lacrimal gland biopsy. Consult with internist if necessary.

Answer 11

B. Keflex or hospitalize if condition becomes severe

Question 12

What is the treatment for chronic dacryoadenitis?

A. cool compresses, analgesic and daily follow ups
B. Keflex or hospitalize if condition becomes severe
C. Treat underlying symptoms and lacrimal gland biopsy. Consult with internist if necessary.

Answer 12

C. Treat underlying symptoms and lacrimal gland biopsy. Consult with internist if necessary.