Lacrimal gland swellings
 

Swelling(s) of the lacrimal gland usually presents as mass(es) in the upper lateral margin. A common cause of  bilateral lacrimal swellings is sarcoidosis, the patient is usually of African or Afro-Carribean origin.  There are bilateral swellings of the lateral orbital margin. Palpation reveals firm masses which are not mobile. Look for signs of sarcoidosis: skin nodules on the lids (from sarcoid infilatration) or purple-red infiltration of the nose (lupus pernio) examine the anterior segment for dry eyes and anterior uveitis if the pupil were dilated, look for any signs of vasculitis which is typically described 'candle-wax' palpate the parotid glands for enlargement and examine the mouth for dry mouth (Mikulicz's syndrome)

Questions:

1. What is Mikulicz's syndrome?

Answer
Mikulicz's syndrome is characterised by bilateral swelling of lacrimal and salivary glands with dry eyes and dry mouth. There are several causes for this syndrome.

2. What is the differentiate diagnosis of a patient with bilateral lacrimal gland swelling?

Answer
Although tumours and infection can cause lacrimal gland swellings they rarely do so bilaterally. Inflammation and infiltration are much more common causes of bilateral lacrimal gland swelling:
sarcoidosis
lymphoma
leukaemia

3. Below are two chest X-ray of two patients with sarcoidosis. What do they show?
 

CXR 1 Answer CXR 1 shows bilateral lymphadenopathy

CXR 2 Answer CXR 2 shows diffuse pulmonary  fibrosis.

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Sarcoid nodules involving the medial aspect of the upper lid Return to the top Lupus pernio. Note the purpurlish infiltration of the nose Return to the top Vasculitis in sarcoidosis. Note the candlewax appearance of the retinal vessels. Return to the top