ISSN - 0973-0958

Pediatric Oncall Journal

Bilateral Eye Swelling

Catarina Santiago Gonçalves1,2, Filipa Urbano1, José Gonçalo Marques1,3, Ana Mouzinho3.
1Division of Infectious Diseases and Immunology, Department of Pediatrics, Santa Maria Hospital, Lisbon University Hospital Center, Lisbon, Portugal,
2Department of Pediatrics, Women and Child Health Services, Holy Spirit of Evora Hospital, Lisbon, Portugal,
3University Clinic of Pediatrics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.

Catarina Santiago Gonçalves, Largo do Sr. da Pobreza, 7000-811 Évora, Portugal.
Dacryoadenitis, adenovirus, eyelid edema, chemosis, conjunctival pseudomembrane.

A previously healthy 6-year-old boy was admitted to the emergency department with fever, cervical lymphadenopathy, bilateral eyelid edema and erythema, with almost complete closure of the palpebral fissures, exuberant chemosis and photophobia (Figure 1). He had no recent history of respiratory tract infections, no apparent cutaneous portal of entry or contact with someone with similar symptoms. On physical examination, pupils were equally round and reactive to light, but the evaluation of extraocular muscle movements and visual field testing were not possible due to eyelid edema. Computed tomography (CT) of the orbits and sinuses revealed bilateral enlargement of lacrimal glands (Figure 2). Treatment with systemic amoxicillin + clavulanic acid and topical prednisolone and chloramphenicol was started, and he was regularly observed by an ophthalmologist. He responded well to treatment and resolution of eyelid edema, conjunctival pseudomembranes were observed. Serological studies were consistent with acute adenovirus infection (positive IgM/negative IgG antibodies) and past Epstein-Barr virus (EBV) infection (positive viral capsid antigen (VCA) IgG antibodies; negative VCA IgM antibodies; positive EBV nuclear antigen (EBNA)1 IgG antibodies). The patient had a full recovery and remained well two years later.

Figure 1. Edema and erythema of the upper eyelids and bilateral chemosis.
<b>Figure 1.</b> Edema and erythema of the upper eyelids and bilateral chemosis.

Figure 2. Computed tomography of the orbits showing bilateral enlargement of the lacrimal glands (blue arrows).
<b>Figure 2.</b> Computed tomography of the orbits showing bilateral enlargement of the lacrimal glands (blue arrows).

Figure 1. Edema and erythema of the upper eyelids and bilateral chemosis.
  Bilateral Eye Swelling
What is the diagnosis?

Dacryoadenitis. It is the inflammation of the lacrimal gland, rarely bilateral, which may be due to infectious, inflammatory or autoimmune causes, or it may be idiopathic.1 In children it usually has a viral etiology, most frequently attributed to Epstein-barr virus and rarely to Adenovirus.2 Acute adenovirus infection seems the likely etiology in our patient.
Clinical manifestations of dacryoadenitis depend on whether the disease process is acute or chronic.1,2,3 Acute dacryoadenitis usually presents with erythema and tenderness over the area of the lacrimal gland with associated enlargement of the gland and pain.3,4 There may be suppurative discharge, conjunctival chemosis and swollen lymph nodes, usually cervical and preauricular.3,4 Additional eye symptoms such as photophobia, tearing or a foreign body sensation may also occur. Fever and malaise may also occur.3,4 On the other hand, chronic dacryoadenitis, frequently presents in a more indolent manner and it is associated with painless enlargement of the lateral eyelids over several months.2,4,5
The diagnosis of dacryoadenitis is based on physical examination and a thorough eye examination.2 A CT scan of the orbit may be helpful, and it may reveal diffuse enlargement of the lacrimal gland, with marked enhancement with contrast (not observed in chronic dacryoadenitis) as was seen in our patient.1,3 A laboratory evaluation may be performed to assess the etiology of this disease.2,3
Treatment and prognosis depend on the underlying etiology.3,5 Viral dacryoadenitis, the most frequent, is usually self-limiting and only supportive measures are needed, like warm compresses and oral nonsteroidal anti-inflammatories.5 If the etiology is unclear, which happened initially in our case, empirical antibiotics should be initiated with an oral penicillin derivative or a first-generation cephalosporin.4,5 If the lacrimal gland enlargement does not subside after 2-4 weeks of treatment or if there is a high suspicion of malignancy, a lacrimal gland biopsy should be performed and the treatment and prognosis will depend on the underlying situation.3,5
Compliance with ethical standards
Funding:  None  
Conflict of Interest:  None

  1. Gao Y, Moonis G, Cunnane ME, Eisenberg RL. Lacrimal gland masses. AJR Am J Roentgenol. 2013; 201:W37181.  [CrossRef]
  2. Tirkey E, Chandravanshi SL, Jain S, Mishra V. Presumed Acute Adenoviral Dacryoadenitis Associated with Epidemic Keratoconjunctivitis: A Case Report. Nigerian Journal of Ophthalmology. 2014; 22:90-92.  [CrossRef]
  3. Patel R, Patel BC. Dacryoadenitis. StatPearls Publishing. 2021. Available from: Accessed on 11th June 2021
  4. American International Medical University. Dacryoadenitis: Symptoms, Causes, Diagnosis and Management. 2017 February 10 [cited 2021 June 1]. Available from:
  5. Medscape. Dacryoadenitis. 2018 June 19 [cited 2021 June 1]. Available from:

Cite this article as:
Gonçalves C S, Urbano F, Marques J G, Mouzinho A. Bilateral Eye Swelling. Pediatr Oncall J. 2022;19. doi: 10.7199/ped.oncall.2022.18
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