This document discusses dry eye and dacryoadenitis. It outlines the objectives of diagnosing and treating dry eye using tests like tear film break-up time and treatment options like artificial tears. It also describes acute and chronic dacryoadenitis, their causes which can include viruses and bacteria, signs, investigations and medical care involving antibiotics or treating underlying infections. Prognosis is generally good for acute cases but dependent on treating chronic systemic conditions for chronic dacryoadenitis.
7. Acute dacryoadenitis
History
Unilateral.
severe pain&redness.
pressure in the supratemporal region
of the orbit.
Chronic dacryoadenitis
History
Can be bilateral, painless enlargement
of the lacrimal gland present for more
than a month
More common
8. Acute dacryoadenitis
Signs
Pain
Lymphadenopathy (preauricular)
Swelling of the lateral third of the upper lid
(S-shaped lid)
Chronic dacryoadenitis
Signs
Less severe presentation
No pain
Enlarged gland but mobile
Mild ptosis
9. CAUSES
viral dacryoadenitis (most common)
Mumps (most common, especially in childhood)
Herpes zoster
Cytomegalovirus
bacterial dacryoadenitis
Staphylococcus aureus and Streptococcus
Neisseria gonorrhoeae
Chlamydia trachomatis
Mycobacterium tuberculosis.
N.B Gram-positive organisms are the most common cause of acute bacterial
dacryoadenitis
fungal dacryoadenitis (rare)
N.B Chronic dacryoadenitis is usually seen with chronic systemic conditions (eg,
sarcoidosis)
10. INVESTIGATIONS
Laboratory
Acute >>Smear and culture if purulent discharge is noted.
Blood cultures to rule out N gonorrhoeae infections
Chronic>>Lacrimal gland biopsy (If the enlargement does not subside after 2
weeks )
Imagining
CT scan of the orbits with contrast
Acute>>The affected lacrimal gland shows diffuse enlargement+marked
enhancement with contrast.
Chronic >> the same as Acute but no enchancement with contrast
The lesion may be bilateral .
11. MEDICAL CARE
• Viral>> Self-limiting, supportive measures (eg, warm compresses, oral nonsteroidal
anti-inflammatories)
• Bacterial>>first-generation cephalosporins eg, Keflex 500 mg .
• If the patient needs to be hospitalized because of the severity of illness, then use IV
cefazolin (Ancef).
• Protozoan or fungal >> Treat the underlying infection with specific antiamoebic or
antifungal agents.
• Inflammatory (noninfectious) >> Investigate for systemic etiology, and treat it .
12. Acute>> 2-6 weeks after beginning the initial treatment.
Chronic>>Patient should receive follow-up care, in
conjunction with the primary care physician.
Follow up
prognosis
Acute>> prognosis is good , self limiting in most cases.
Chronic>>Prognosis is dependent on the management
of the associated chronic systemic condition
