Bilateral lacrimal gland enlargement: Clinical features and outcomes

Sonia Huang, Valerie Juniat, Khami Satchi, Liza M. Cohen, Garry Davis, Daniel B. Rootman, Alan McNab, Dinesh Selva

Meeting:  2022 RANZCO


Date:      -

Session Title: FREE PAPERS – Oculoplastic/Ocular Oncology

Session Time:      -

Purpose: Patients with bilateral lacrimal gland disease are a unique subset of patients where there is a paucity of literature. This presentation often represents systemic disease or malignancy and can cause diagnostic difficul ties. We aim to discuss the diagnoses and features of bilateral lacrimal gland disease.

Method: Retrospective multi-centre case seriesinvolving 115 patients with bilateral lacrimal gland disease from 1995 to 2020.

Results: One hundred and fifteen patients were included. Their ages ranged from 9 to 85 (mean 47.3 years) with a female predominance (73, 63.5%). The most common cate gory of diagnosis was inflammatory (69, 60%) followed by lymphoproliferative (23, 20%), structural (17, 14.8%) and other conditions (6, 5.2%). The five most common specific diagnoses were IgG4 related disease (20, 17.4%) and idio- pathic orbital inflammatory disease (20, 17.4%), lym- phoma (16, 13.9%), lacrimal gland prolapse (13, 11.3%) and sarcoidosis (11, 9.6%). Corticosteroid treatment was used most commonly (29, 25.2%) followed by observa- tion (25, 21.7%). At last follow up, the majority of patients had complete resolution, significant improve- ment with mild residual disease or stable disease with- out further progression (104, 90.4%).

Conclusion: Bilateral lacrimal disease may be due to a range of aetiologies, most of which are systemic. The most common are inflammatory and lympho- proliferative conditions. Due to the wide range of aetio- logies of bilateral lacrimal gland disease, it is extremely difficult to accurately determine a cause based on clinical findings alone, highlighting the vital role of lacrimal gland biopsy in patients presenting with bilateral lacrimal gland disease.