Dacryoadenitis: Symptoms, Types, Causes and Treatment

Dacryoadenitis is an inflammation of the lacrimal (tear-producing) gland, a condition that can arise from multiple causes and present with a wide array of symptoms. Understanding this condition is critical not only for eye health professionals but also for patients who may experience unexplained swelling or pain around the eyes. This comprehensive guide delves into the key symptoms, types, underlying causes, and the most up-to-date treatments for dacryoadenitis, drawing on recent research and clinical insights.

Symptoms of Dacryoadenitis

Dacryoadenitis often presents suddenly, but symptoms can also develop gradually depending on the underlying cause. Recognizing these symptoms early can help guide prompt diagnosis and management, preventing complications and improving outcomes for patients.

Main Symptom	Additional Signs	Symptom Onset	Sources
Eyelid swelling	Redness, pain, tenderness	Acute/Chronic	1,2,3,5,7
Ptosis (drooping lid)	Diplopia, discharge, restricted eye movement	Acute	2,1
Visual changes	Decreased acuity, field loss	Variable	1,3
Dry eye/epiphora	Corneal ulcer, chemosis	Chronic/Acute	1,3
Systemic symptoms	Fever, malaise (if infectious)	Acute	2,4

Table 1: Key Symptoms

Common Ocular Symptoms

The hallmark symptom of dacryoadenitis is swelling of the outer portion of the upper eyelid, often accompanied by redness and pain. In acute cases, the onset is rapid, and the affected area may be tender and warm to the touch. Chronic forms may present with less dramatic but persistent swelling and discomfort 2,3,5.

Additional eye-related symptoms may include:

• Ptosis: Drooping of the upper eyelid due to gland enlargement 2,1.
• Diplopia: Double vision if inflammation spreads to adjacent tissues or restricts eye movement 1,2.
• Visual Disturbances: Decreased visual acuity or field loss, especially if the inflammation extends to the optic nerve or compresses the globe 1,3.
• Dry Eye or Epiphora: Reduced tear production or excessive tearing, reflecting impaired gland function 1,3.
• Corneal Ulcer/Chemosis: Rare but may occur with severe chronic inflammation 1,3.

Systemic and Other Associated Symptoms

Infectious dacryoadenitis, particularly the acute suppurative form, may be accompanied by fever, malaise, or purulent discharge from the lacrimal duct 2,13. Systemic autoimmune forms can present alongside symptoms of underlying diseases, such as joint pain, dry mouth, or skin rashes (seen in conditions like Sjögren’s syndrome or systemic lupus erythematosus) 4,9.

Symptom Variability

• Acute Onset: Typically more dramatic, with pain, redness, and rapid swelling 2.
• Chronic Onset: Slower development, often less painful, with persistent fullness or mild discomfort 3,5.
• Bilateral vs. Unilateral: Bilateral involvement is more common in chronic, especially autoimmune, forms 1,7.

Types of Dacryoadenitis

Dacryoadenitis is not a one-size-fits-all diagnosis. It encompasses various types, each with distinct clinical features, underlying mechanisms, and implications for management.

Type	Key Features	Laterality	Sources
Acute suppurative	Rapid, painful, purulent	Usually unilateral	2,13,11
Chronic nonspecific	Slow, mild inflammation	Often bilateral	3,5,7
IgG4-related	Bilateral, systemic links	Bilateral/multisystem	1,7
Autoimmune (Sjögren, SLE, Sarcoid, Crohn)	Dryness, systemic features	Bilateral	4,8,14,16
Idiopathic	No identifiable cause	Unilateral/bilateral	5,6,15

Table 2: Types of Dacryoadenitis

Acute Suppurative Dacryoadenitis

This type is typically caused by bacterial infection. Patients present with sudden, painful swelling, redness, and tenderness over the lacrimal gland. Purulent discharge and systemic symptoms such as fever may be present 2,13. Abscess formation is possible and may require surgical intervention 2,11.

Chronic Nonspecific Dacryoadenitis

Characterized by mild, persistent swelling and redness, this form is more common in older adults and is often bilateral. Symptoms are less severe, and the gland may feel firm but not acutely tender 3,7.

IgG4-Related Dacryoadenitis

A newer recognized subtype, IgG4-related dacryoadenitis presents with bilateral, often painless gland enlargement. It is frequently associated with other IgG4-related diseases (such as autoimmune pancreatitis and sialadenitis) and may extend inflammation beyond the gland to adjacent tissues 1,7. Serum IgG4 levels are typically elevated.

Autoimmune Dacryoadenitis

Autoimmune conditions like Sjögren’s syndrome, systemic lupus erythematosus (SLE), sarcoidosis, and Crohn's disease can cause dacryoadenitis 4,8,14,16. These patients may have other systemic symptoms, such as dry mouth, joint pain, or gastrointestinal complaints.

Idiopathic Dacryoadenitis

When no specific cause is found, the condition is termed idiopathic. It is the most common non-infectious type and may present similarly to other forms but lacks systemic features or identifiable underlying disease 5,6,15.

Causes of Dacryoadenitis

Understanding the cause of dacryoadenitis is crucial for effective treatment. While infection is a common trigger, immune-mediated and idiopathic forms are increasingly recognized.

Cause	Examples/Agents	Typical Type Triggered	Sources
Bacterial	Staphylococcus aureus, skin flora, MRSA	Acute suppurative	2,13
Viral	Mumps, Epstein-Barr, others	Acute	9
Parasitic	Cysticercus cellulosa	Acute suppurative	11
Autoimmune	Sjögren’s, SLE, Sarcoid, Crohn's	Chronic/Autoimmune	4,8,9,14,16
IgG4-mediated	IgG4-related disease	Chronic	1,7
Idiopathic	Unknown	Idiopathic	5,6,15

Table 3: Major Causes of Dacryoadenitis

Infectious Causes

• Bacterial: The most common bacteria are Staphylococcus aureus and other skin flora, but MRSA and rare pathogens can also cause infection 2,13. Infection may result from local spread (e.g., sinusitis) or systemic illness.
• Viral: Less common, but mumps and other viruses can cause acute dacryoadenitis, especially in children 9.
• Parasitic: Rarely, parasites such as cysticercus cellulosa can trigger an acute inflammatory response 11.

Immune-Mediated Causes

• Autoimmune diseases: Sjögren’s syndrome is a classic cause, often presenting with dry eyes and mouth. SLE, sarcoidosis, and Crohn’s disease can all involve the lacrimal gland 4,8,9,14,16.
• IgG4-related disease: Now recognized as a major cause of chronic and bilateral dacryoadenitis, especially in middle-aged to older adults 1,7.

Idiopathic

In a significant proportion of cases—especially those with chronic, non-specific inflammation—no clear cause is found, even after thorough investigation. These are classified as idiopathic dacryoadenitis 5,6,15.

Other and Rare Causes

• Drug-induced: Checkpoint inhibitor immunotherapy (e.g., anti-PD-1 antibodies) can cause autoimmune dacryoadenitis as a side effect 12.
• Sex hormones: Animal studies suggest a role for male gonadal hormones in promoting dacryoadenitis in certain models 10.

Treatment of Dacryoadenitis

Treatment for dacryoadenitis is highly dependent on the underlying cause and severity. Prompt recognition and tailored therapy can prevent complications and preserve gland function.

Treatment	Indication	Efficacy/Notes	Sources
Antibiotics	Acute bacterial infection	IV/oral, cover staph/MRSA	2,13,11
Surgical drainage	Abscess/poor response	Required for abscess	2,11
Corticosteroids	Immune-mediated, idiopathic	Effective, but relapse possible	1,5,9,15
Immunosuppressants	Autoimmune (SLE, Sjögren)	Mycophenolate, others	4,14,16
Biopsy/surgical excision	Chronic/idiopathic	Diagnostic and therapeutic	5,6,7,15
Mesenchymal stem cells (MSCs)	Autoimmune/refractory	Experimental, promising	14,16

Table 4: Main Treatment Options

Acute Infectious Dacryoadenitis

• Antibiotics: Empirical intravenous (IV) or oral antibiotics effective against Staphylococcus aureus and skin flora are first-line for bacterial cases 2,13. Coverage for MRSA may be necessary in high-risk settings.
• Surgical drainage: Indicated if there is abscess formation or if the infection does not resolve with medication 2,11.

Immune-Mediated and Idiopathic Dacryoadenitis

• Corticosteroids: Systemic steroids are highly effective for most immune-mediated and idiopathic cases, although relapse can occur, especially with high IgG4 levels or associated autoimmune diseases 1,5,9.
• Immunosuppressive agents: In cases associated with systemic autoimmune disease (e.g., SLE, Sjögren's), immunosuppressants such as mycophenolate mofetil may be used, often in combination with corticosteroids 4,14,16.
• Biopsy and surgical debulking: Surgical intervention is often both diagnostic and therapeutic, especially in idiopathic cases where steroids alone are insufficient or contraindicated 5,15. In some patients, surgical debulking leads to long-term remission 15.

Advanced and Experimental Therapies

• Mesenchymal stem cell (MSC) therapy: Emerging data suggest MSCs may reduce inflammation and modulate immune responses in autoimmune dacryoadenitis, though these therapies remain experimental 14,16.
• Other immunomodulatory agents: For refractory cases, targeted therapies may be considered depending on the underlying systemic disease.

Supportive Measures

• Artificial tears and lubricants: Helpful for symptomatic relief in chronic or autoimmune dacryoadenitis 16.
• Systemic evaluation: All patients—especially those with chronic or bilateral disease—should be assessed for underlying systemic illness 1,4,7,9.

Conclusion

Dacryoadenitis is a diverse condition with a range of causes, clinical presentations, and treatment strategies. Early recognition and a tailored diagnostic approach—including consideration of systemic disease—are critical for effective management and optimal outcomes.

Key Points:

• Dacryoadenitis presents with swelling, pain, and sometimes visual symptoms; severity and additional features depend on the underlying cause.
• Types include acute suppurative, chronic, IgG4-related, autoimmune, and idiopathic forms, each with unique features.
• Causes range from infections (bacterial, viral, parasitic) to autoimmune and idiopathic mechanisms.
• Treatment is cause-dependent, including antibiotics, corticosteroids, immunosuppressants, and sometimes surgery.
• Emerging therapies, such as mesenchymal stem cell transplantation, show promise for refractory autoimmune dacryoadenitis.

An integrated, patient-centered approach—combining clinical, laboratory, and imaging assessments—is essential for accurate diagnosis and individualized therapy in dacryoadenitis.