Dacryoadenitis: Greek expert explains why 1 in 10 patients will visit the eye doctor


Mrs. Dimitra Portaliou, an Ophthalmologist, Ophthalmoplasty Surgeon, and Director of the 2nd Ophthalmology Clinic at Metropolitan Hospital, explains the unusual and rare disorder of dacryoadenitis.

Lacrimal adenitis, or dacryoadenitis, is an unusual and rare eye disorder characterised by swelling of one or both lacrimal glands due to inflammation (in most cases, one of the two glands). The glands are almost the size of an almond from which tears are produced, and any irritation to the large tear glands can lead to inflammation and swelling.

Although there is no exact record, a study has estimated that 1 in 10 eye patients may experience dacryoadenitis during their lifetime.

The discomfort from the inflammation can be transient or persistent, but if not treated promptly and correctly, it may develop into a serious disease that damages the patient's eye.

Forms of dacryoadenitis

Dacryoadenitis is divided into acute and chronic.

Acute dacryoadenitis, we have when it manifests itself within a few hours or days, on the one hand, only with intense symptoms, such as pain, redness, swelling of the conjunctiva, swelling of the upper eyelid, purulent secretions, while there may be signs of upper respiratory infection, fever, swelling of the parotid glands and swollen lymph nodes.

Chronic dacryoadenitis occurs when the swelling lasts over a month on both sides. The symptomatology is not intense; there is no pain, but there may be symptoms of dry eyes. However, in very severe cases, the lacrimal gland may protrude beyond the eyelid into the outer upper part of the eye.

What causes dacryoadenitis?

Lacrimal gland disorder is usually caused by inflammation, an autoimmune disease (such as Graves' thyroid gland disease), or an underlying malignancy, such as lymphoma. When it occurs unexpectedly, it is usually caused by a bacterial or viral infection. In very rare cases, the infection can also be caused by fungi or parasites.

In even rarer cases, as reported in the medical literature (there are few reports), the SARS-CoV-2 coronavirus may be the agent causing the inflammation.

Symptoms of dacryoadenitis

Inflammation of the lacrimal gland can cause swelling around the upper outer corner of the eye, causing drooping of the eyelid, tearing, swollen lymph nodes near the ear, redness of the eye, and a burning sensation.

Patients may also feel pain when moving the affected eye. Ecchymosis with corresponding hypophagia in the eye's conjunctiva may also occur.

Usually, dacryoadenitis does not affect vision. However, if the swelling is large enough and presses on the eye, it can also cause a disturbance in this function or even diplopia. If you notice unusual changes in one or both eyes, such as pain, swelling, or a change in colour, it is recommended that you see your doctor.

Also, if you notice a sudden decrease or loss of vision, rapid worsening of swelling in the eye, severe pain and/or you start seeing "lights" or "flies" in your field of vision, you must visit the doctor immediately to stop the progression of the disease.

How is the diagnosis made?

Dacryoadenitis can be diagnosed based on medical history and clinical examination. If the patient has received corticosteroids before the examination, the cortisone can inhibit the clinically critical findings of the condition, mainly the swelling of the associated lymph nodes.

Blood tests may also be needed to check various markers of inflammation. At the same time, a biopsy of the lacrimal gland may be requested to rule out the possibility of a lump inside it and to perform imaging tests, such as CT and MRI.

How is dacryoadenitis treated, and how long does it take?

Antiviral drugs or antibiotics for bacterial infections may be required when dacryoadenitis is acute. It is vital that patients take the medications recommended by their ophthalmologist consistently and for as long as needed.

Even if the symptoms weaken or disappear completely, they should not stop treatment prematurely, as there is a risk of relapse. Most likely, in a second relapse, the infection will be more intense than initially.

Treatment of chronic dacryoadenitis usually depends on controlling the underlying autoimmune condition. The doctor may also prescribe corticosteroid medications (cortisone) to treat inflammation and swelling in the eye.

Whether the dacryoadenitis is acute or chronic, the patient can take additional measures to relieve themselves, such as resting the eyes, using warm patches (compresses), and using pain relievers.

The eye doctor will give instructions on how often and for how long the warm pads should be used.

Typically, acute dacryoadenitis resolves completely in 4-6 weeks; however, chronic may persist and recur. Recovery progress depends on the timely initiation of treatment, the cause of the infection, and the existing state of health.

Is there a case of hospitalisation for dacryoadenitis?

If treatment is delayed or not applied correctly, there is a risk of developing an abscess in the eye or inflammation of the cells (cellulitis). In such cases, the patient should be closely monitored in the hospital and receive intravenous antibiotic therapy.

At the same time, surgery may be required to open the abscess.

How can I prevent the appearance of inflammation?

The best practice is to follow the rules of hygiene, with frequent hand washing and avoiding touching the eyes with dirty hands. However, if you have an autoimmune disease that can cause dacryoadenitis, preventing it may not be possible.

The Metropolitan Hospital has developed an Ophthalmology department that operates according to the standards of international ophthalmology centres. It has experienced and specialised surgeons and staff who provide comprehensive medical services, including psychological support.

The equipment is state-of-the-art, with state-of-the-art machines and systems that ensure accurate diagnosis and the provision of effective treatment. The operating theatres are equipped to deal with any planned or emergency surgery incident, with excellent technique and nursing support.

Dimitra Portaliou is an Ophthalmologist - Ophthalmoplasty Surgeon, Director of the 2nd Ophthalmology Clinic at Metropolitan Hospital. Translated by Paul Antonopoulos.

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