====== Dacryoadenitis ======
- inflammation of the lacrimal gland (main or accessory)

===== Etiology =====
  * 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
    * [[sjogren_syndrome|Sjögren's syndrome]] 
    * IgG4 related disease
    * Granulomatosis with polyangiitis
    * Idiopathic orbital inflammation
    * Sarcoidosis
  * Neoplasms
    * Lymphoma
    * Adenoid cystic carcinoma
    * Pleomorphic adenoma 

===== Symptoms and Signs =====
  * 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

===== Testing =====
  * 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

===== Treatment =====
  * 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

======= Resources =======
[[https://eyewiki.aao.org/Dacryoadenitis|Eye Wiki]]