Biopsies are key for accurately diagnosing bilateral lacrimal gland disease

Australian investigators analyzed case data to determine the clinical features of lacrimal gland disease.

Study design

This was a retrospective multicenter case study of 115 patients with bilateral lacrimal gland disease treated between 1995 and 2020. All patients were required to have either a serological test or biopsy to be included.

Outcomes

Sixty-four percent of patients were female, and the mean age was 47.3 years. Sixty percent of conditions were considered to be inflammatory, 20% to be lymphoproliferative, and 15% to be structural. The main specific diagnoses made were immunoglobulin G4–related disease, idiopathic orbital inflammation, lymphoma, lacrimal gland prolapse, and sarcoidosis. Patients with inflammatory disease were significantly younger than patients with other types of diseases. Patients presenting with periorbital edema, conjunctival injection, and/or pain were more likely to have an inflammatory condition, while patients presenting with globe dystopia and change in visual acuity were more likely to have lymphoproliferative disease.

Limitations

As this was a multicenter case study, not all patients had the same workup, which may have confounded diagnoses. A uniform workup of these patients would add valuable information.

Clinical significance

This study highlights the association of bilateral lacrimal gland processes with systemic disease. An appropriate workup, including serologic investigations, imaging, and biopsy, is likely necessary to ensure accurate diagnosis in this patient population.