Chronic dacryoadenitis |
Acute dacryoadenitis |
Acute dacryoadenitis may develop as a primary inflammation of the lacrimal gland or secondary to some local or systemic infection. Dacryoadenitis secondary to local infections occurs in trauma, conjunctivitis (especially gonococcal and staphylococcal) and orbital cellulite.
Dacryoadenitis secondary to systemic infection is associated with mumps, influenza, measles and infectious mononucleosis. Thus acute dacryoadenitis is most commonly caused by viral or bacterial infection.
Acute dacryoadenitis is characterized by a painful swelling of the outer portion of the upper eyelid (the region of the lacrimal gland). The lid is red and swollen with a typical s-shaped curve of its margin. These symptoms last only for a few hours or days.
Chronic dacryoadenitis is usually due to noninfectious inflammatory disorders affecting the lacrimal gland. Examples include thyroid eye disease, orbital pseudotumor and sarcoidosis. Chronic dacryoadenitis can last for much longer periods, sometimes over years. It comes with painless or slightly painful swelling in the upper and outer part of the lids with the eyeball displaced down and in.
Treatment options vary according to whether the dacryoadenitis is acute or chronic as well as the likely cause Acute cases only require monitoring for a period of up to six weeks, whereas chronic cases may need many months of consultations.
Prior to any tests, a full examination of family background and medical history should be undertaken which may give an indication of the likelihood of a systemic underlying cause for the inflammation.
Fortunately the disease is either acute or chronic with the chronic form being quite rare; the acute form runs its course and is contained but the chronic version requires that the underlying condition (such as thyroid eye disease) needs to be properly managed.
The discharge, if any, produced in an acute type inflammation should be tested by laboratory culture to ascertain presence of any bacterial infections. If the condition is caused by virus, (which as is the most common), then the patient can be left to self administer the treatment programme set out by the optometrist which consists of mild massaging and warm compresses.
If the condition is caused bacteria then a course of antibiotics needs to be followed. It is important that the optometrist prescribing the treatment ensures that the patient understands the need to take the full course of drugs even if inflammation seems to have substantially cleared.
If the cause is fungal then the initiation requires application of anti-fungal agents.
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