Idiopathic dacryoadenitis: clinical features, histopathology, and treatment outcomes

PURPOSE: 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. DESIGN: Retrospective interventional case series. METHODS: SETTING: Tertiary referral centers. PATIENTS: Seventy-nine cases of biopsy-confirmed idiopathic dacryoadenitis. OBSERVATION PROCEDURES: The following data were reviewed: age, sex, laterality, symptom onset, clinical presentation, histopathology, treatment response, and recurrence. MAIN OUTCOME MEASURES: Rates of treatment recalcitrance, incomplete treatment response, and recurrence. RESULTS: 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 extra ocular 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. CONCLUSION: 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. (C) 2016 by Elsevier Inc. All rights reserved.