Idiopathic Dacryoadenitis: Clinical Features, Histopathology, and Treatment Outcomes.

Abstract

To review the clinical and histologic features of idiopathic dacryoadenitis, and to assess prognostic factors associated with disease recurrence, treatment recalcitrance, and incomplete treatment response. Retrospective interventional case series. setting: Tertiary referral centers. Seventy-nine cases of biopsy-confirmed idiopathic dacryoadenitis. The following data were reviewed: age, sex, laterality, symptom onset, clinical presentation, histopathology, treatment response, and recurrence. Rates of treatment recalcitrance, incomplete treatment response, and recurrence. Idiopathic dacryoadenitis patients had a mean age of 50 years, 57% were female, and 16% of cases were bilateral. Fifty-two percent had inflammation extending to adjacent structures on imaging. Twenty percent were recalcitrant to treatment, 17% had an incomplete treatment response, and 15% of patients had a recurrence during a mean follow-up time of 64 months. Risk factors for an incomplete treatment response were male sex (P = .01) and inflammation extending to extraocular muscle (P = .01). A clinical presentation of "classic" dacryoadenitis was a risk factor for treatment recalcitrance (P = .02). Bilateral cases were younger than unilateral cases (P = .004) and had an increased risk of recurrence (P = .05). Sclerosing cases were associated with an insidious onset of symptoms (P = .009), but neither histopathology nor the speed of symptom onset was associated with a poor prognosis. Thirty-seven percent of idiopathic dacryoadenitis had a poor response to treatment and 15% of cases recurred. The prognostic factors identified in this study have not been reported previously and may inform management.