chronic dacryodenitis
Introduction
Introduction to chronic lacrimal gland inflammation Chronic lacrimal gland is clinically more common than acute lacrimal gland inflammation, often associated with systemic infections. Mostly primary, can also be caused by acute changes, the lesions are mostly bilateral, there is a pain-free bulge on the upper side of the upper eyelid, but there may be pain, the mass can also touch the lobulated, accompanied by the eyeball down The inner side shifts, the upturn is limited, and the double vision occurs or the ptosis performance is caused. The main causes of chronic lacrimal gland inflammation are: bacterial infection, trauma and metastasis. Among them, bacterial infection is the most common, and 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 onset, sometimes epidemic, with obvious systemic symptoms. Staphylococcal edema, streptococci-induced scarlet fever, Streptococcus pneumoniae and Escherichia coli infection, mostly purulent, one side of the lacrimal gland. basic knowledge The proportion of illness: 0.02% - 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: decreased secretion of lacrimal gland, lacrimal gland tumor
Cause
Causes of chronic lacrimal gland inflammation
Bacterial infection (37%):
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 onset, sometimes epidemic, with obvious systemic symptoms. Staphylococcal edema, streptococci-induced scarlet fever, Streptococcus pneumoniae and Escherichia coli infection, mostly purulent, one side of the lacrimal gland.
Trauma (20%):
Local sources, penetrating wounds, burns, often cause local suppuration or necrosis, staphylococcal infection of the meibomian glands or conjunctiva, mumps, sputum cellulitis, etc. can directly spread to the lacrimal gland.
Lesion metastasis (20%):
Metastasis of the lesion, distant purulent lesions, such as tonsillitis, otitis media, dental caries, pyelonephritis and so on.
Prevention
Chronic lacrimal gland prevention
Exercise regularly to improve your body's immunity. The diet should be regular and reasonable, that is, high-protein, high-vitamin foods. Choose plant or animal protein with high nutritional value, such as milk, eggs, fish, lean meat, various soy products, etc. A variety of fresh vegetables, fruits and fruits are rich in vitamins and have high nutritional value. Avoid excessive eye fatigue. Use your eyes to feel tired and pay attention to the correct eye position, distance, light source and so on. Use an eye for about an hour, let your eyes relax, such as closing your eyes, walking, looking at the sky or in the distance, so that your eyes can rest. Try not to read and work in a dimly lit environment for a long time.
Complication
Chronic lacrimal gland complications Complications of lacrimal gland secretion, lacrimal gland tumor
In the chronic inflammation of the lacrimal gland and parotid gland swelling, accompanied by tuberculosis, leukemia, lymphoma, sarcoma nodules or uveitis, parotid fever, it is called Migueliz syndrome.
Symptom
Chronic lacrimal gland symptoms common symptoms lacrimal gland enlargement parotid gland enlargement margin "S" shaped drooping parotid gland swollen uveitis lacrimal gland inflammation eyelid abscess eyelid edema swollen ear lymph nodes swollen hepatosplenomegaly
1, tuberculous lacrimal gland inflammation: the most common type, with the spread of blood, bilateral or unilateral swelling, no pain, accompanied by lymphadenopathy before the ear, often manifested as isolated tuberculoma, most can The more, but there is also cheese-like necrosis, forming a cold abscess, and forming a tuberculous fistula after piercing the skin.
2, trachomatis lacrimal gland: trachoma on the lacrimal gland may have two aspects: First, the trachoma in the process of scarring, causing obstruction of the lacrimal gland discharge tube - leading to atrophy of the lacrimal gland; first, trachoma virus invading the lacrimal gland along the drainage tube And the formation of trachomatis lacrimal gland, but need to be fully confirmed.
3, lacrimal gland sarcoma nodule tumor: is a kind of erosion of the reticular endothelial system granulation inflammation, the reason is not clear, often a local symptom of systemic disease, patients mostly occur between the ages of 20 to 40, bilateral onset, but Not necessarily at the same time, the lacrimal gland appears to be gradually swollen, disease-free nodular, hard texture, associated with sputum tissue, but can be promoted freely under the skin and sacral margin, and the final diagnosis depends on biopsy.
4, Mikutiez disease (Mikutiez disease: typical is the bilateral lacrimal gland and parotid gland swelling of chronic inflammation, multiple 30 years of age or older, can occur at any age, the cause is unknown, most of the beginning is slow, there may be acute Initially, unilateral, secondary to bilateral, without pain and systemic reaction, lacrimal gland swelling, symmetrical, soft, movable, elastic, no tenderness, sometimes with hepatosplenomegaly and systemic lymphadenopathy Often, at the same time or in a few weeks or years, the parotid gland begins to symmetry, sometimes invading the lacrimal glands and glands, reducing the amount of salivation, causing dryness in the mouth, nose, and throat.
5, in the chronic inflammation of the lacrimal gland and parotid gland swelling, accompanied by tuberculosis, leukemia, lymphoma, sarcoma nodules or uveitis, parotid fever, it is called Migueliz syndrome.
Examine
Chronic lacrimal gland examination
1. Physical examination:
Pay attention to whether the upper edge of the iliac crest touches the mass, whether there is eyeball protrusion and eye movement disorder.
2. Auxiliary inspection:
Blood routine tests were performed for white blood cell counts and classification tests. Blood routine is the most common and basic blood test. Blood consists of two major parts, fluid and tangible cells, which are routinely tested for blood. Blood has three different functions of cells - red blood cells (commonly known as red blood cells), white blood cells (commonly known as white blood cells), and platelets. The disease is judged by observing the quantitative change and the morphological distribution. It is one of the commonly used auxiliary examination methods for doctors to diagnose the disease.
Diagnosis
Diagnosis and differentiation of chronic lacrimal gland
Differential diagnosis
1. Mikulicz syndrome. An unexplained bilateral chronic lacrimal gland inflammation accompanied by bilateral parotid swelling. More common in young adults, the lacrimal gland is swollen and soft, and some cases have liver, spleen and lymph nodes. Due to the involvement of the parotid gland, saliva secretion is reduced, and patients often complain of dry mouth and nasopharynx. For example, when combined with systemic leukemia, tuberculosis, lymphosarcoma, and sarcoidosis, it is Mikulicz syndrome.
2. Thyroid-related diseases. The lesions mainly damage the upper and the extraocular muscles. Commonly: (1) the eyelids are retracted, especially the above-mentioned tendon retraction is the most common, the clinical cleft palate is large, and the upper edge of the cornea and the upper sclera are exposed. When the eyeball looks down, the upper jaw does not move down with the eyeball, saying that the eyelid is stagnant. The number of blinks is reduced and often shows a gaze. (2) The eyeball protrudes forward, and diplopia and eye movement are limited. Mainly caused by extraocular muscle lesions, early hypertrophic edema, cell infiltration, late degeneration and fibrous speech, limiting eye movement. Early eyeball limitation is easier to detect. The first to be affected is the inferior rectus muscle, followed by the medial rectus muscle, the upper rectus muscle again, and the outer rectus muscle is the least affected. The hypertrophic extraocular muscle can be seen at the tip of the ankle. Oppression of the optic nerve, causing visual impairment or even loss. (3) often accompanied by conjunctival hyperemia. In addition, eyelid retraction and stagnation of the eyeball can cause difficulty in cleft palate closure, leading to exposed keratitis, corneal ulcer, and serious threat to vision.
3. Lacrimal gland tumors. (1) lacrimal gland mixed tumor: a lump appears on the outer side of the eyelid, which develops slowly, and the eyeball protrudes inward and downward without bone destruction. (2) lacrimal gland columnar tumor: a hard mass of lacrimal gland, adhesion to bone, irregular surface, rapid development, pain with double vision, and more fundus changes.
