title: Idiopathic Dacryoadenitis: Clinical Features, Histopathology, and Treatment Outcomes.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective interventional case series.
  
  
  METHODS
  setting: Tertiary referral centers.
  
  
  METHODS
  Seventy-nine cases of biopsy-confirmed idiopathic dacryoadenitis.
  
  
  METHODS
  The following data were reviewed: age, sex, laterality, symptom onset, clinical presentation, histopathology, treatment response, and recurrence.
  
  
  METHODS
  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 extraocular 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: South Australian Institute of Ophthalmology, Royal Adelaide Hospital, and the University of Adelaide, Adelaide, Australia. Electronic address: nick.h.andrew@gmail.com.
authors.forename: Nicholas H
authors.initials: NH
authors.lastname: Andrew
authors.affiliation: South Australian Pathology, Royal Adelaide Hospital, and the University of Adelaide, Adelaide, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kearney
authors.affiliation: South Australian Pathology, Royal Adelaide Hospital, and the University of Adelaide, Adelaide, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Sladden
authors.affiliation: The Royal Eye and Ear Hospital and the Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne, Melbourne, Australia.
authors.forename: Penny
authors.initials: P
authors.lastname: McKelvie
authors.affiliation: South Australian Institute of Ophthalmology, Royal Adelaide Hospital, and the University of Adelaide, Adelaide, Australia.
authors.forename: Albert
authors.initials: A
authors.lastname: Wu
authors.affiliation: South Australian Institute of Ophthalmology, Royal Adelaide Hospital, and the University of Adelaide, Adelaide, Australia.
authors.forename: Michelle T
authors.initials: MT
authors.lastname: Sun
authors.affiliation: The Royal Eye and Ear Hospital and the Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne, Melbourne, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: McNab
authors.affiliation: South Australian Institute of Ophthalmology, Royal Adelaide Hospital, and the University of Adelaide, Adelaide, Australia.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001379:Azathioprine / Q000627:therapeutic use; D001706:Biopsy; D002648:Child; D003607:Dacryocystitis / Q000188:drug therapy* / Q000473:pathology*; D004351:Drug Resistance; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011239:Prednisolone; D014222:Triamcinolone Acetonide; D001379:Azathioprine; D008727:Methotrexate