Inflammation of the lacrimal gland and lacrimal sac

Inflamation of the lacrimal gland (dacryoadenitis)

 * mostly one-sided
 * it occurs mainly in children and young people
 * is acute or chronic

Acute lacrimal gland inflammation

 * often a complication of other diseases (mononucleosis, influenza, typhus, scarlatina)
 * less often, the cause of inflammation is the onset of infection in conjunctivitis
 * the originators are:


 * 1) viruses (EBV, HZV, Influenzaviruses)
 * 2) bakteria (Streptococci)

Clinical symptoms

 * swelling of the outer third to the middle of the upper eyelid
 * very painful
 * the edge of the lid is sigmoideal curved
 * tearing and conjunctival chemosis, sometimes enlarged preauricular nodes
 * differential diagnosis: chalazion, hordeolum, tumor
 * if a tumor is suspected, we do not perform a biopsy in any case, which could harm the patient by the occurrence of metastases or recurrence

Therapy

 * for viral dacryoadenitis, we administer analgesics and cold compresses
 * in the case of bacterial origin, we treat with antibiotics or incisions

Chronic lacrimal gland inflammation

 * bilateral
 * it is often part of systemic diseases (sarcoidosis)
 * bulbus is oppressed nasally down → exophthalmos

Acute dacryocystitis

 * in young children or people over 40 years of age
 * the reason is mainly an obstacle in the outflow of tears due to narrowing or closure of the tear duct when:


 * 1) congenital obstruction ductus nasolacrimalis
 * 2) stone or outcrop in lacrimal duct
 * 3) after surgery in the oral cavity or jaw
 * 4) after trauma


 * infection of accumulating secretion occurs most often by bacteria Staphylococcus aureus, H. influenzae, Proteus vulgaris rarely Candida albicans.

Clinical symptoms

 * lacrimation (epiphora)
 * the pain is likened to a renal colic, spreading to the middle of the head and teeth
 * lacrimation and secretion in the inner corner
 * the lacrimal sac is red and edematous, it may contain mucous secretions

Complications: transfer of infection to orbit

Therapy

 * in the first phase of the disease we administer ATB, we do not try to probe (there would be a risk of spreading the infection)
 * later incision and drainage
 * if it persists, we solve the problem surgically using a dacryocystorhinostomy

Chronic dacryocystitis

 * arises in creeping, alternating periods of calm and inflammatory activity
 * manifested by tearing, the lacrimal sac may be swollen with mucus

Therapy

 * Antibiotics can only alleviate symptoms, but do not lead to permanent elimination of the problem
 * dacryocystorhinostomy