Dacryoadenitis is an inflammatory lesion of the lacrimal gland. It rarely occurs on its own, more often it serves as a complication of various diseases. There are acute and chronic forms. Clinically acute dacryoadenitis is manifested by edema and pain in the projection of the lacrimal gland, a change in the shape of the eye slit. The chronic process is manifested by a moderate painless enlargement of the gland, mild hyperemia of the conjunctiva. Diagnostics includes examination, visometry, tonometry, biomicroscopy. To clarify the etiology of the chronic form, a number of studies are additionally prescribed. Conservative treatment (antibiotics, physiotherapy), surgical treatment for the formation of an abscess of the gland.
Dacryoadenitis (dacryoadenitis: Greek. dakryon tear + adēn gland) is an acute or chronic inflammation of the lacrimal gland. This gland is an element of the accessory apparatus of the eye, belongs to the tubular glands, has the shape of a horseshoe and consists of two parts. Its functioning creates optimal conditions for the normal functioning of the eyeball. Diseases of the lacrimal gland are an infrequent phenomenon, reaching 0.56% in the population. Dacryoadenitis accounts for approximately 25% of all lacrimal gland lesions. Acute dacryoadenitis in ophthalmology is quite rare, as a rule, in children with weakened immunity, against the background of infectious diseases. In adults, pathology manifests itself in a chronic form. Men and women get sick with the same frequency.
Acute and chronic dacryoadenitis are isolated. The acute form is a complication of many infectious diseases, for example, influenza, sore throat, mumps, intestinal infections and others. The chronic process occurs against the background of an active form of tuberculosis, syphilis, blood diseases (chronic lymphocytic leukemia). In recent years, the main role in the development of chronic dacryoadenitis has been assigned to nonspecific inflammation of the lacrimal gland in sarcoidosis, Wegener’s granulomatosis, reactive arthritis. Less often, chronic dacryoadenitis is based on Mikulich’s disease, which proceeds with lymphomatous hyperplasia, which also affects the salivary, submandibular and parotid glands.
The symptoms of the acute form of dacryoadenitis are characterized by a sharp onset, the patient complains of pain during palpation in the projection of the lacrimal gland. There is hyperemia and swelling of the outer part of the upper eyelid, which lead to the development of a specific S-shaped ptosis and a slight deviation of the eye inside and down. The movement of the eye is disrupted in full. The injection of the conjunctival part of the lacrimal gland and sclera is visualized. The patient also notes dryness in the eye due to a decrease in tear production. The lesion is more often unilateral and is accompanied by symptoms of general intoxication: hyperthermia, headache, weakness and enlargement of regional lymph nodes.
The course of the chronic form of dacryoadenitis in various diseases is similar to each other. The lacrimal gland is enlarged, compacted and painless on palpation. Mild conjunctival hyperemia and superficial injection of sclera vessels are possible. Due to minor ptosis against the background of an enlarged lacrimal gland, the eye slit is reduced in size from the outside. Eye movements are not disturbed. Dry eye syndrome is not characteristic, more often tear production is not disturbed for a long time. Symptoms develop gradually, and more than one month may pass before contacting an ophthalmologist. Pathology has a one- or two-sided character.
Diagnosis of acute dacryoadenitis is carried out by an ophthalmologist with the help of visual examination and anamnesis collection, visometry, tonometry, biomicroscopy of the eye. The clinical picture of the acute form is pronounced, does not cause difficulties. To diagnose chronic dacryoadenitis, an ultrasound of the eyeball, MRI or CT is additionally performed (if a neoplasm of the eyelid or lacrimal gland is suspected). In order to clarify the etiology of inflammation, an additional chest X-ray examination is performed (to determine changes in lung tissue), a Mantoux test, treponemal serological tests, a biopsy of lung tissue (if lung sarcoidosis is suspected) or a salivary gland (if Mikulich’s disease is suspected).
Treatment of acute form is more often conservative, chronic form – depending on the underlying disease. The conservative course of treatment of acute dacryoadenitis is carried out in a hospital, includes physiotherapy (UHF therapy, dry heat), the appointment of antibacterial (oral or intramuscular), anti-inflammatory drugs, analgesics. Intensive treatment of the underlying disease is carried out. Surgical intervention is required for the formation of a lacrimal gland abscess. The abscess is opened, the wound is thoroughly washed with a solution of hydrogen peroxide or other antiseptic, drainage is installed until the wound surface is completely cleaned.
Treatment of chronic dacryoadenitis depends on the etiology of the underlying disease and is carried out jointly with other specialists (hematologist, venereologist or phthisiologist). With long-term, poorly treatable dacryoadenitis, it is necessary to carry out X-ray irradiation of the lacrimal gland area (moderate doses). The prognosis in acute form is favorable, in chronic dacryoadenitis depends on the course of the underlying disease.
The most effective way to prevent dacryoadenitis is to strengthen the immune system. Sports, proper nutrition, walking in the fresh air, abstaining from alcohol and cigarettes – all this significantly reduces the risk of infectious diseases that can lead to acute dacryoadenitis. During an epidemic of influenza or SARS, it is necessary to regularly carry out wet cleaning of the apartment, wash your hands more often, avoid places of mass gatherings of people. In addition, timely detection and competent treatment of major diseases (syphilis, tuberculosis, sarcoidosis) significantly reduces the risk of dacryoadenitis.