Lacrimal Gland Dacryolithiasis With Secondary Bacterial Dacryoadenitis: Clinicoradiological Characterization and Review of Literature.
Ayushi Agarwal, Jai Paris, Dinesh Selva
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Case in brief
A 32-year-old woman presented with four days of painful right lacrimal gland swelling. MRI showed an enlarged, enhancing gland containing nonenhancing intraglandular foci with low T2 signal and marked restricted diffusion. Excision identified multiple noncalcified ductal dacryoliths centered on an impacted eyelash. Cultures grew Streptococcus pneumoniae, and histopathology showed acute inflammation. Her symptoms had completely resolved at one-month follow-up, with no evidence of recurrence.
What made this case unusual
Dacryolithiasis presented as acute dacryoadenitis, rather than the more typical refractory conjunctivitis or chronic lateral conjunctival or canthal mass. The MRI foci showed low T2 signal and marked restricted diffusion.
Diagnostic / clinical pearl
In acute lacrimal gland swelling, intraglandular foci with low T2 signal and restricted diffusion may suggest dacryoliths; excision and microbiological and histopathological evaluation can establish the diagnosis and identify associated infection.