dacryodenitis
Introduction
Introduction to lacrimal gland Acute lacrimal gland inflammation (acutedacryoadenitis) is not common, due to infection or idiopathic inflammation, the lacrimal gland appears acute redness and enlargement in a short period of time. Chronic lacrimal gland inflammation (chronicdacryoadenitis) is more common than acute lacrimal gland inflammation, which can be delayed by acute lacrimal gland inflammation. The disease progresses slowly, mostly bilateral and unilateral. Acute lacrimal gland inflammation is caused by various infectious diseases, such as mumps, influenza, typhoid fever, pneumonia, acute pharyngitis, etc. It can also be the result of the spread of inflammation around the tissue. Bilateral or unilateral onset, the lacrimal gland of the ankle is more susceptible to the lacrimal gland than the ankle. basic knowledge The proportion of illness: 0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: meningitis, ocular dyskinesia, dry keratoconjunctivitis
Cause
Causes of lacrimal gland inflammation
Disease factors (40%):
The infection may be invaded or blood-borne by the conjunctival sac via the lacrimal gland duct. There may be upper respiratory tract infections before the onset, sometimes epidemic, with obvious systemic symptoms. Infections from distant purulent lesions, such as tonsillitis, otitis media, dental caries, pyelonephritis, etc. Systemic infections such as edema caused by staphylococci, scarlet fever caused by streptococcus, Streptococcus pneumoniae and Escherichia coli infection, mostly suppurative, one side of the lacrimal gland.
Trauma factors (30%):
Perforation, burns, often cause local suppuration or necrosis; staphylococcal infection of the meibomian gland or conjunctiva, mumps, cellulitis, etc. can directly spread to the lacrimal gland.
Pathogenesis
The primary infection of the lacrimal gland is related to the general condition. The secondary infection is mostly caused by systemic blood circulation or local infection through the lymphatic or lacrimal gland discharge catheter retrograde into the lacrimal gland tissue, triggering the lacrimal gland inflammation reaction, according to the different immune status and pathogenesis of the body. The size of the virulence of the bacteria, there are different pathological processes.
Prevention
Lacrimal gland prevention
Lacrimal gland inflammation is mainly caused by various infectious diseases, such as mumps, influenza, typhoid fever, pneumonia, acute pharyngitis, etc., but also the result of the spread of inflammation around the tissue. Because the most important preventive measure is to stay away from the disease-infected people and strengthen physical exercise.
Complication
Lacrimal gland inflammation Complications meningitis eye movement disorder dry keratoconjunctivitis
Cavernous sinus embolism, basal meningitis, ocular dyskinesia and dry keratoconjunctivitis.
Symptom
Symptoms of lacrimal gland symptoms common symptoms tears eyeballs prominent edema abscess congestion and feeding tears rim margin transverse "S" shape drooping sag ptosis ear lymph nodes swollen lacrimal gland prolapse
Primary people are more common in children and young adults, often unilateral, involving the lacrimal gland of the ankle, and the lacrimal glands of the ankle and the lacrimal glands of the ankle can be afflicted separately or simultaneously.
Acute axillary lacrimal gland: redness, swelling, pain, tearing discomfort on the lateral side of the upper eyelid, sag in the transverse "S" shape, swelling can spread to the sputum, cheeks, swollen lymph nodes in the ear, tenderness, sputum And solid mass, there is tenderness, no adhesion to the sacral wall and sacral margin, conjunctival congestion and edema on the sacral conjunctiva, lacrimal gland tissue congestion, mucus-like secretions, may be associated with fever, headache, general malaise, if Early appropriate anti-infective treatment, more than 1 to 2 weeks of inflammation subsided, and some sub-acute, only 1 to 2 months to resolve, a small amount of suppuration from the upper conjunctiva perforation, pus discharge into the conjunctival sac or temporarily formed fistula, It can heal in 2 to 3 weeks.
Acute axillary lacrimal gland inflammation: local symptoms similar to sacral lacrimal gland inflammation, severe pain and conjunctival edema is light, can be squat and mass in the upper lateral humerus, the eyeball protrudes inward and downward, outward, upper movement limited and accompanied There are diplopia, generally more in the short-term use of drugs after the inflammation is dissipated, subacute patients with a longer time to resolve, a small amount of suppuration, pus from the upper skin of the upper jaw, can form a fistula.
Chronic lacrimal gland inflammation: There is no obvious clinical symptoms of acute lacrimal gland inflammation. The lacrimal gland can touch the nodule locally. The pain is not obvious. It can be active. The eyelids can be red and swollen. After the abscess is formed, there may be fluctuations. When the lacrimal gland is enlarged, it may appear. The ptosis and eye movement disorders.
Examine
Lacrimal gland examination
1. Blood test: In the acute phase, routine blood tests can be performed to determine the nature and extent of the infection.
2. Histopathological examination: feasible lacrimal gland tissue biopsy, according to different histopathological findings can determine the type of inflammation of the lacrimal gland.
3. B-ultrasound: the abnormal echo of the apricot nucleus in the lacrimal gland, the boundary is clear, the sound sulcus is visible between the eyeball and the enlarged lacrimal gland, and the compressibility is not obvious. It shows that the lacrimal gland enlarges into a petal-like structure, and the boundary is not neat. The internal echo is uneven (Fig. 3), and the fascial sac edema of the eyeball can be displayed at the same time.
4. CT: transverse axis and coronary CT showed a flattened lacrimal gland, prominent temporal margin, adjacent extraocular muscle thickening, sometimes combined with eye ring thickening, bilateral onset is not uncommon, some with sinus inflammation.
5. MRI: MRI showed that the lacrimal gland on the lateral side of the eye was swollen and surrounded by the eyeball. Both T1WI and T2WI showed a medium signal, which was obvious. Because the lesion was adjacent to the orbital skin, enhanced MRI could show the surrounding soft tissue signal enhancement.
Edema in the lobules, mainly lymphocyte infiltration, visible plasma cells; polymorphonuclear leukocytes can be seen in the tissues of infectious acute lacrimal gland inflammation.
Diagnosis
Lacrimal gland inflammation diagnosis
According to the patient's medical history and clinical manifestations, combined with local signs, especially acute lacrimal gland inflammation, the diagnosis is not difficult, but for chronic lacrimal gland inflammation, it is important to distinguish the lacrimal gland tumor disease.
Mainly related to the disease that causes the lacrimal gland enlargement, such as lacrimal gland mixed tumor, lymphoma, etc., lacrimal gland mixed tumor is the most common benign tumor of lacrimal gland, unilateral onset, manifested as nodular in the armpit, soft tissue mass with clear boundary, Peripheral structures such as extraocular muscles change, and malignant bone destruction can occur. Lymphomas, such as lacrimal glands, can cause lacrimal gland enlargement, and irregular masses can also be seen in the iliac crest.
