Acute inflammation of the lacrimal gland (dacryoadenitis) is most often seen in association with inflammatory disease and occasionally is the consequence of malignancy, such as lymphoproliferative disease. Noninfectious disease of the lacrimal gland is covered in Chapter 4. Infectious dacryoadenitis is unusual, and gross purulence and abscess formation are uncommon. However, with the emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA), this condition is seen more frequently. Most cases are the result of bacterial infection, which may develop secondary to an adjacent infection, after trauma, or hematogenously. Alternatively, MRSA infection may appear without preexisting risk factors. Given the rare occurrence of these infections, large case series are lacking, as are a precise breakdown of causative organisms and suggestions for management. Presumably, most cases are due to gram-positive bacteria, but cases due to gram-negative bacteria have been documented. There are case reports of dacryoadenitis related to tuberculosis, involving the formation of discrete tuberculomas in several cases. Epstein-Barr virus is the most frequently reported viral pathogen. Many nonsuppurative cases are treated empirically, without isolation of the alleged pathogen; coverage for MRSA infection should be considered.
Mathias MT, Horsley MB, Mawn LA, et al. Atypical presentations of orbital cellulitis caused by methicillin-resistant Staphylococcus aureus. Ophthalmology. 2012;119(6): 1238–1243.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.