The lacrimal glands, commonly known as tear glands, are a pair of exocrine glands that produce the aqueous layer of tears to lubricate, nourish, and protect the eye surface. When one or both glands become inflamed, the resulting swelling is medically termed dacryoadenitis. This condition signifies an underlying process, such as an infection, a systemic inflammatory disease, or, less commonly, a mass, requiring medical attention. Dacryoadenitis can present acutely with rapid onset or chronically as a long-term issue, making understanding the cause essential for effective management.
Location and Physical Signs
The lacrimal glands are situated within the orbit, located in the superior temporal aspect of the eye socket, just beneath the outer part of the upper eyelid. Each gland has two main parts: the larger orbital lobe and the smaller palpebral lobe. The palpebral lobe can sometimes be seen by everting the upper eyelid.
Swelling is typically observed as an enlargement on the outer portion of the upper eyelid. This swelling can push the eyelid downward, creating a distinct S-shaped curve along the eyelid margin. Acute inflammation often causes the overlying skin to be tender, warm, and red.
Pain in the area of swelling is common, and pressure from the enlarged gland may make it difficult to move the eye. Other symptoms include excessive tearing (epiphora) or discharge, and swelling of the lymph nodes located in front of the ear (preauricular lymphadenopathy). Severe swelling can place pressure on the eye, potentially distorting vision.
Common Causes of Lacrimal Gland Inflammation
The causes of lacrimal gland inflammation are varied and are categorized based on their presentation: acute or chronic. Acute dacryoadenitis, which is sudden in onset and typically affects only one eye, is most often caused by an infectious agent. The infection frequently ascends into the gland from the conjunctiva, though it can also originate from the skin or bloodstream.
Viral infections are the most frequent cause of acute dacryoadenitis, especially in younger individuals. Common viral culprits include the Epstein-Barr virus (EBV), mumps virus, adenoviruses, and the herpes zoster virus. Bacterial infections like Staphylococcus aureus and Streptococcus pneumoniae also cause acute cases and can sometimes lead to a purulent stage with abscess formation.
Chronic dacryoadenitis involves long-term or persistent swelling and is usually caused by systemic inflammatory or autoimmune disorders, rather than infection. These conditions involve the immune system mistakenly attacking the lacrimal gland tissue, causing inflammation and enlargement.
Other systemic conditions, such as Sjögren’s syndrome, which targets moisture-producing glands, and sarcoidosis, characterized by the formation of inflammatory cells, can cause chronic enlargement. Less commonly, swelling is caused by a benign or malignant tumor, which may present as a painless, firm enlargement. A neoplastic process must be carefully excluded during the diagnostic workup.
Medical Evaluation and Diagnostic Steps
A healthcare provider begins the diagnostic process with a thorough patient history and a detailed physical examination. The history focuses on the onset, duration, and severity of symptoms, as well as any associated systemic symptoms like fever or signs of a recent infection. The physical exam includes a close inspection of the eyelid and gland area, an evaluation of the preauricular lymph nodes, and a complete eye exam.
Laboratory tests often include blood work to check for markers of infection or systemic inflammation. For acute cases, purulent discharge may be collected for smear and culture to identify a specific bacterial agent. In chronic cases, blood tests may look for antibodies or indicators associated with autoimmune conditions such as Sjögren’s syndrome or sarcoidosis.
Imaging techniques are employed to assess the extent of the swelling and to rule out a mass within the orbit. A computed tomography (CT) scan or magnetic resonance imaging (MRI) provides detailed images of the enlarged gland. If imaging reveals an atypical appearance, such as a mass, a biopsy of the lacrimal gland may be necessary. Histopathological analysis of the tissue is the definitive method for distinguishing between inflammation and a neoplastic process.
Targeted Treatment Strategies
The treatment for lacrimal gland swelling is tailored to the underlying cause identified through the diagnostic workup. For acute dacryoadenitis caused by a viral infection, the condition is typically self-limiting and management is primarily supportive. This supportive care involves rest, warm compresses applied to the affected area, and over-the-counter pain relievers like ibuprofen or acetaminophen to manage discomfort.
If a bacterial infection is confirmed or strongly suspected, treatment involves a course of oral antibiotics. Failure to improve after a few days of antibiotic therapy may prompt a re-evaluation of the diagnosis or consideration of an abscess, which might require surgical drainage.
Corticosteroids are the primary medical treatment for noninfectious inflammatory dacryoadenitis, as they reduce inflammation and swelling. Patients with conditions like Sjögren’s syndrome or sarcoidosis may require systemic immunosuppressive therapy. If the cause is neoplastic, treatment involves specialized oncological care, including surgery, radiation therapy, or chemotherapy, depending on whether the tumor is benign or malignant.