Periorbital infections – those infections that occur near the eye socket – can be grouped into two categories:
• Periorbital cellulitis – affecting the skin surrounding the inside of the eye
• Infections of the lacrimal system
Dacryoadenitis is one of several inflammations of the lacrimal system, along with blepharitis, dacryocystitis and canaliculitis; in particular it is concentrated in the lacrimal gland which functions to produce tears to lubricate and clean the eye.
What causes Dacryoadenitis?
An infection of the lacrimal gland through bacteria or a virus initiates the inflammation. A bout of mumps can stimulate onset, as well as the so called Epstein-Barr and Herpes zoster viruses.
Two types of inflammation are described in medical terms as:
• Acute – meaning that the symptoms last only for a few hours or days.
• Chronic – the dacryoadenitis can last for much longer periods, sometimes over years and typically caused by disorders such as thyroid eye disease.
Fortunately the disease in either acute or chronic form is 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.
What are the Symptoms?
The symptoms vary according to whether the dacryoadenitis is acute or chronic.
• The outermost part of the upper eyelid swells up
• The swelling is painful, especially when touched
• The swelling has a reddish colour and feels slightly warm
• Excessive amount of tears, sometimes with a discharge
• Symptoms are unilateral – occurring on only one side of the face
• Symptoms are usually bilateral – swelling occurring in both lacrimal eye glands
• If pain exists it is much less than that felt in the acute condition
• No excessive tears – the exact opposite may occur resulting in dry eyes
In both acute and chronic cases it’s not unusual for symptoms such as sore throat and swollen jaw glands to be present.
Prior to any tests, a full examination of family background and medical history should be undertaken – this may give an indication of the likelihood of a systemic underlying cause for the inflammation.
The discharge, if any, produced in an acute type inflammation should be tested by laboratory culture to ascertain presence of any bacterial infections.
Treatment options vary obviously according to whether the dacryoadenitis is acute or chronic as well as the likely cause:
If the cause is viral, as is most common, then the patient can be left to self administer the treatment programme set out by the optometrist, consisting of warm compresses and careful massaging.
If the cause is bacterial then a course of antibiotics needs to be followed. It is important that the optical professional 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.
A fungal initiation requires application of anti-fungal agents.
These cases, being caused by other disorders, need to be addressed by treating firstly the underlying disorder.
Acute cases only require monitoring for a period of up to six weeks, whereas chronic cases may need many months of consultations.