2020–2021 BCSC Basic and Clinical Science Course™
7 Oculofacial Plastic and Orbital Surgery
Part I: Orbit
Chapter 5: Orbital Neoplasms and Malformations
Lacrimal Gland Tumors
Nonepithelial Tumors of the Lacrimal Gland
The vast majority of nonepithelial lesions of the lacrimal gland represent lymphoid proliferation or inflammations, discussed earlier in this chapter and in Chapter 4 of this volume.
Benign lymphocytic infiltrates may be seen in patients, particularly women, who have bilateral swelling of the lacrimal gland, producing a dry eye syndrome. This condition can occur insidiously or following a symptomatic episode of lacrimal gland inflammation. The enlargement of the lacrimal glands may not be clinically apparent. Biopsy specimens of the affected glands show a spectrum of lymphocytic infiltration, from scattered patches of lymphocytes to lymphocytic replacement of the lacrimal gland parenchyma with preservation of the inner duct cells, which are surrounded by proliferating myoepithelial cells (epimyoepithelial islands). This combination of lymphocytes and epimyoepithelial islands has led some authors to designate this manifestation as a lymphoepithelial lesion. Some patients with lymphocytic infiltrates may also have systemic rheumatoid arthritis and, therefore, have classic Sjögren syndrome. These lesions may develop into low-grade B-cell lymphoma (see the section Lymphoproliferative Disorders). Associated dry eye symptoms may improve with the use of topical cyclosporine.
Shields JA, Shields CL, Epstein JA, Scartozzi R, Eagle RC Jr. Review: primary epithelial malignancies of the lacrimal gland: the 2003 Ramon L. Font lecture. Ophthalmic Plast Reconstr Surg. 2004;20(1):10–21.
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.