title: Bilateral lacrimal gland disease: clinical features of 97 cases.
abstract: 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.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Ninety-seven patients with bilateral LG disease.
  
  
  METHODS
  Retrospective review and statistical analysis using analysis of variance and the Fisher exact test.
  
  
  METHODS
  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 were more 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%, with 25% 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%.
authors.affiliation: Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Sunny X
authors.initials: SX
authors.lastname: Tang
authors.affiliation: Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Renelle P
authors.initials: RP
authors.lastname: Lim
authors.affiliation: Ocular Oncology, Wills Eye Institute, Philadelphia, Pennsylvania; King Saud University, College of Medicine, Riyadh, Saudi Arabia.
authors.forename: Saad
authors.initials: S
authors.lastname: Al-Dahmash
authors.affiliation: Texas Oculoplastic Consultants, Austin, Texas.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Blaydon
authors.affiliation: Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Raymond I
authors.initials: RI
authors.lastname: Cho
authors.affiliation: Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Christina H
authors.initials: CH
authors.lastname: Choe
authors.affiliation: Oculoplastics and Orbital Consultants, West Palm Beach, Florida.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Connor
authors.affiliation: Department of Ophthalmology, Anschutz Medical Campus, University of Colorado, Denver, Colorado.
authors.forename: Vikram D
authors.initials: VD
authors.lastname: Durairaj
authors.affiliation: Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Eckstein
authors.affiliation: Department of Ophthalmology, Emory University, Atlanta, Georgia.
authors.forename: Brent
authors.initials: B
authors.lastname: Hayek
authors.affiliation: Department of Ophthalmology, Rutgers Biomedical and Health Sciences, Newark, New Jersey.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Langer
authors.affiliation: Department of Ophthalmology, Weill Cornell Medical College, New York, New York.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Lelli
authors.affiliation: Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Ronald
authors.initials: R
authors.lastname: Mancini
authors.affiliation: Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York.
authors.forename: Alexander
authors.initials: A
authors.lastname: Rabinovich
authors.affiliation: Department of Ophthalmology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Javier
authors.initials: J
authors.lastname: Servat
authors.affiliation: Texas Oculoplastic Consultants, Austin, Texas.
authors.forename: John W
authors.initials: JW
authors.lastname: Shore
authors.affiliation: Department of Ophthalmology, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Sokol
authors.affiliation: Department of Ophthalmology, Franzco Macquarie University, Sydney, Australia.
authors.forename: Angelo
authors.initials: A
authors.lastname: Tsirbas
authors.affiliation: Department of Ophthalmology, Albany Medical College, Albany, New York.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Wladis
authors.affiliation: Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York.
authors.forename: Albert Y
authors.initials: AY
authors.lastname: Wu
authors.affiliation: Ocular Oncology, Wills Eye Institute, Philadelphia, Pennsylvania.
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
authors.affiliation: Ocular Oncology, Wills Eye Institute, Philadelphia, Pennsylvania.
authors.forename: Carol
authors.initials: C
authors.lastname: Shields
authors.affiliation: Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York; Texas Oculoplastic Consultants, Austin, Texas. Electronic address: shinder.roman@gmail.com.
authors.forename: Roman
authors.initials: R
authors.lastname: Shinder
mesh_terms: D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002648:Child; D005260:Female; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017678:Sex Distribution; D013256:Steroids / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D013256:Steroids