- inflammation of the lacrimal gland (main or accessory)
- Infection
- Viral most common
- Epstein-Barr most common
- Adenovirus
- Varicella Zoster
- Herpes Simplex
- Rhinovirus
- Cytomegalovirus
- Mumps
- Bacterial
- Staph aureus
- Streptococcus
- Tuberculosis
- Fungal
- Parasitic
- Autoimmune
- Thyroid eye disease
- IgG4 related disease
- Granulomatosis with polyangiitis
- Idiopathic orbital inflammation
- Sarcoidosis
- Neoplasms
- Lymphoma
- Adenoid cystic carcinoma
- Pleomorphic adenoma
- Symptoms
- Pain in the superior lateral orbit with touch or eye movements
- Droopy upper lid
- Difficulty opening lid
- Eye redness
- Diplopia
- Malaise
- Signs
- tenderness, edema, erythema, induction in superior lateral orbit
- lid ptosis
- conjunctival injection with or without chemosis
- regional lymphadenopathy
- proptosis
- limitation of ocular motility
- Vison loss rare
- Fever
- Imaging
- CT orbits- for adults and older children
- Chest radiograph (if considering sarcoidosis)
- MRI orbits- for children and in recurrent disease in adults
- Laboratory studies to consider
- CBC with differential
- ESR and/or C-reactive protein- evaluate inflammatory response
- Conjunctival swab for viral PCR
- ANA
- SSA/SSb antibodies
- Serum IgG4
- Thyroid function test
- Thyroid autoimmune antibodies
- Biopsy
- transeptal or trans-conjunctival biopsy of lacrimal gland in severe, persistent or recurrent cases
- Surgery for abscess or mass
- Antibiotic for bacterial infection
- Broad spectrum
- Oral Corticosteroids for idiopathic cases
- Methotrexate or rituximab for refractory cases
- Orbital radiation for refractory cases
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