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Clinical Sciences
September 2006

Dacryoadenitis Associated With Acanthamoeba Keratitis

Author Affiliations

Author Affiliations: Departments of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa (Drs Tomita, Shimmura, Tsubota, and Shimazaki), and Keio University School of Medicine, Tokyo (Drs Shimmura, Tsubota, and Shimazaki), Japan.

Arch Ophthalmol. 2006;124(9):1239-1242. doi:10.1001/archopht.124.9.1239

Objective  To report the incidence of dacryoadenitis as a symptom associated with Acanthamoeba keratitis.

Methods  We investigated all cases of Acanthamoeba keratitis (20 patients and 21 eyes) diagnosed and treated at Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan, between May 1, 1994, and November 30, 2005. We recorded the incidence of dacryoadenitis diagnosed using clinical signs of lacrimal gland swelling and pain on pressure, computed tomography, magnetic resonance imaging, and histopathologic analysis.

Results  Eight eyes (38%) of 8 patients had dacryoadenitis simultaneously with Acanthamoeba keratitis. Dacryoadenitis was diagnosed using histopathologic analysis and computed tomography in 1 patient, histopathologic analysis and magnetic resonance imaging in 1, magnetic resonance imaging in 2, and clinical signs alone in 4. Histopathologic examination in 2 patients revealed moderate infiltration of lymphocytes and plasma cells in the lacrimal gland compatible with dacryoadenitis. No Acanthamoeba organisms were found in the lacrimal gland. The standard protocol for Acanthamoeba keratitis was performed without particular treatment of dacryoadenitis in all patients. Lacrimal gland swelling improved after a mean of 10 weeks (range, 4-17 weeks) in conjunction with symptoms of keratitis; however, 1 patient (patient 1) required levator muscle surgery and blepharoplasty for residual ptosis.

Conclusion  Dacryoadenitis is a clinical finding associated with Acanthamoeba keratitis.