Isolated Lacrimal Gland Enlargement in Thyroid-Related Orbitopathy

Abstract

Thyroid-related orbitopathy (TRO) is considered to be an inflammatory autoimmune disorder that commonly presents with extraocular muscle and retrobulbar fat enlargement. Lacrimal gland enlargement in TRO has been reported in the past in association with other radiological findings. Our case represents an isolated lacrimal gland enlargement as a presenting radiological finding in an euthyroid patient showing elevation of thyroid-stimulating immunoglobulin. After ruling out possible pathologies such as a monoclonal process, lacrimal epithelial tumor, or a nonspecific orbital inflammation, the patient underwent orbital decompression, serial botulinum toxin injections, and upper eyelid-retraction surgical correction. After two years of follow-up, the patient developed new-onset diplopia; consequent imaging showed extraocular muscle enlargement which was not present on previous imaging.

Lacrimal Gland Lesions Biopsied in a Tertiary Eye Center in Saudi Arabia: A Clinical, Radiological, Surgical, and Histological Review

“…2,10 It is known that an isolated lacrimal gland enlargement can be an early sign of thyroid-eye disease. 13 In 1981, Trokel and Jakobiec described lacrimal gland enlargement in thyroid-related orbitopathy. 14 Eventually, Harris et al studied the CT scan dimensions of 120 lacrimal glands in Grave's orbitopathy and concluded that the lacrimal gland is significantly enlarged in Grave's orbitopathy.…”

Histopathological features of asymmetric lacrimal gland enlargement in patients with thyroid eye disease

“…Previously reported lacrimal gland histopathological findings in TED have also shown nonspecific inflammatory cell infiltration with and without fibrosis [ 3 , 13 , 14 ]. Of the patients with nonspecific dacryoadenitis in the Ishikawa et al series, inflammatory cells were present with a small amount of fibrotic change in all seven patients and two patients demonstrated germinal centres [ 3 ].…”

“…Of the patients with nonspecific dacryoadenitis in the Ishikawa et al series, inflammatory cells were present with a small amount of fibrotic change in all seven patients and two patients demonstrated germinal centres [ 3 ]. Yahalomi et al described a case of asymmetric lacrimal gland enlargement in a patient with thyroid eye disease with histopathology demonstrating periacinar lymphocytic infiltration [ 13 ]. Khu et al also presented a case report of asymmetric lacrimal gland enlargement in the setting of thyroid eye disease with biopsy showing a mild chronic inflammatory infiltrate composed of plasma cells [ 14 ].…”