- 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
  • Sjögren's syndrome
  • 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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