Dacryoadenitis is inflammation of the tear gland, which sits under the outer part of the upper eyelid. Acute cases are usually viral (such as mumps or Epstein-Barr virus) or bacterial, while chronic cases point to inflammatory diseases such as sarcoidosis, IgG4-related disease or lymphoma.
Key symptoms
- Pain and swelling in the outer part of the upper eyelid
- Redness of the lid and the eye on that side
- S-shaped droop of the upper lid
- Tearing or discharge
- Fever and malaise in acute infection
What you find on exam
- Tender swelling over the tear gland that gives the lid an S shape
- Lift the lid: swollen, red gland visible in the outer upper conjunctiva
- Nearby lymph nodes and parotid glands (mumps, sarcoidosis)
- Vision, eye movements and pupils to rule out orbital cellulitis
Tests
- Usually clinical in mild acute cases
- CT of the orbits with contrast if eye movement is painful or limited, vision changes or the eye bulges
- Blood count; in chronic cases ACE level, IgG4, autoimmune tests or biopsy
Treatment basics
- Viral: warm compresses and NSAIDs; it settles in 1 to 2 weeks
- Bacterial: oral antibiotics such as amoxicillin-clavulanate, IV antibiotics if severe
- Drain an abscess if present
- Chronic or inflammatory: treat the underlying disease, often with steroids, after biopsy
Red flags
- Painful or limited eye movements or a bulging eye (orbital involvement)
- Reduced vision or a relative afferent pupillary defect
- Firm, painless mass that does not settle (possible tumor)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.