TY - JOUR
T1 - Bilateral lacrimal gland disease
T2 - Clinical features of 97 cases
AU - Tang, Sunny X.
AU - Lim, Renelle P.
AU - Al-Dahmash, Saad
AU - Blaydon, Sean M.
AU - Cho, Raymond I.
AU - Choe, Christina H.
AU - Connor, Michael A.
AU - Durairaj, Vikram D.
AU - Eckstein, Lauren A.
AU - Hayek, Brent
AU - Langer, Paul D.
AU - Lelli, Gary J.
AU - Mancini, Ronald
AU - Rabinovich, Alexander
AU - Servat, Javier
AU - Shore, John W.
AU - Sokol, Jason A.
AU - Tsirbas, Angelo
AU - Wladis, Edward J.
AU - Wu, Albert Y.
AU - Shields, Jerry A.
AU - Shields, Carol
AU - Shinder, Roman
N1 - Funding Information:
Supported by the Research to Prevent Blindness , Inc, New York, New York. The sponsor had no role in the design or conduct of this research.
Publisher Copyright:
© 2014 by the American Academy of Ophthalmology.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Objective: Bilateral lacrimal gland (LG) disease is a unique presentation that can result from varied causes. We reviewed the diagnoses, clinical features, and outcomes of 97 patients with this entity.Design: Case series.Participants: Ninety-seven patients with bilateral LG disease.Methods: Retrospective review and statistical analysis using analysis of variance and the Fisher exact test.Main Outcome Measures: Patient demographics, clinical features, diagnostic testing, diagnosis, and treatment.Results: Patient age ranging from 8 to 84 years (mean, 46 years). The predominant gender was female (77%), and race included black (49%), white (38%), and Hispanic (12%) patients. Diagnoses fell into 4 categories: inflammatory (n = 51; 53%), structural (n = 20; 21%), lymphoproliferative (n = 19; 20%), and uncommon (n = 7; 7%) entities. The most common diagnoses included idiopathic orbital inflammation (IOI; n = 29; 30%), sarcoidosis (n = 19; 20%), prolapsed LG (n = 15; 15%), lymphoma (n = 11; 11%), lymphoid hyperplasia (n = 8; 8%), and dacryops (n =5; 5%). Inflammatory conditions weremore likely in younger patients (P<0.05) and in those with pain (P<0.001) and mechanical blepharoptosis (P<0.01) at presentation, whereas lymphoma was more common in older patients (P<0.001) without active signs of inflammation at presentation. Black patients were more likely to have sarcoidosis (P<0.01). Laboratory results showed high angiotensin converting enzyme level being significantly more likely in patients with sarcoidosis (P<0.05). However, sensitivity was limited to 45%, with25%of patients diagnosed with IOI also demonstrating positive results. Corticosteroid therapy was the treatment of choice in 38 cases, corresponding to resolution of symptoms in 29% and improvement in an additional 32%. Overall, chronic underlying disease was found in 71% of patients, among whom 26% achieved a disease-free state, whereas 3% succumbed to their underlying disease.Conclusions: The cause of bilateral lacrimal gland disease most commonly was inflammatory, followed by structural and lymphoproliferative. Patient characteristics and clinical presentations were key features distinguishing between competing possibilities. Despite local control with corticosteroids or radiotherapy, underlying disease continued in 71% of patients and led to death in 3%.
AB - Objective: Bilateral lacrimal gland (LG) disease is a unique presentation that can result from varied causes. We reviewed the diagnoses, clinical features, and outcomes of 97 patients with this entity.Design: Case series.Participants: Ninety-seven patients with bilateral LG disease.Methods: Retrospective review and statistical analysis using analysis of variance and the Fisher exact test.Main Outcome Measures: Patient demographics, clinical features, diagnostic testing, diagnosis, and treatment.Results: Patient age ranging from 8 to 84 years (mean, 46 years). The predominant gender was female (77%), and race included black (49%), white (38%), and Hispanic (12%) patients. Diagnoses fell into 4 categories: inflammatory (n = 51; 53%), structural (n = 20; 21%), lymphoproliferative (n = 19; 20%), and uncommon (n = 7; 7%) entities. The most common diagnoses included idiopathic orbital inflammation (IOI; n = 29; 30%), sarcoidosis (n = 19; 20%), prolapsed LG (n = 15; 15%), lymphoma (n = 11; 11%), lymphoid hyperplasia (n = 8; 8%), and dacryops (n =5; 5%). Inflammatory conditions weremore likely in younger patients (P<0.05) and in those with pain (P<0.001) and mechanical blepharoptosis (P<0.01) at presentation, whereas lymphoma was more common in older patients (P<0.001) without active signs of inflammation at presentation. Black patients were more likely to have sarcoidosis (P<0.01). Laboratory results showed high angiotensin converting enzyme level being significantly more likely in patients with sarcoidosis (P<0.05). However, sensitivity was limited to 45%, with25%of patients diagnosed with IOI also demonstrating positive results. Corticosteroid therapy was the treatment of choice in 38 cases, corresponding to resolution of symptoms in 29% and improvement in an additional 32%. Overall, chronic underlying disease was found in 71% of patients, among whom 26% achieved a disease-free state, whereas 3% succumbed to their underlying disease.Conclusions: The cause of bilateral lacrimal gland disease most commonly was inflammatory, followed by structural and lymphoproliferative. Patient characteristics and clinical presentations were key features distinguishing between competing possibilities. Despite local control with corticosteroids or radiotherapy, underlying disease continued in 71% of patients and led to death in 3%.
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U2 - 10.1016/j.ophtha.2014.04.018
DO - 10.1016/j.ophtha.2014.04.018
M3 - Article
C2 - 24907059
AN - SCOPUS:84908120764
SN - 0161-6420
VL - 121
SP - 2040-2046.e1
JO - Ophthalmology
JF - Ophthalmology
IS - 10
ER -