Sequential right then left acute dacryoadenitis in Crohn's disease

A 41-year-old woman presented with painful swelling of the lateral aspect of the right upper lid along with ipsilateral conjunctival injection. Her right eye had limited abduction and pain on attempted lateral gaze. Funduscopy was normal. Medical history included Crohn's disease treated with sulphasalazine and azathioprine. White blood cell count, erythrocyte sedimentation rate and C reactive protein were raised. CT of orbits revealed right-sided lacrimal gland enlargement, with signs of abscess formation within it. She was treated initially with intravenous antibiotics for 3 days and then switched to orals but it took 2 weeks for full resolution of symptoms. Eight months later, she presented again with signs of acute left-sided dacryoadenitis, not responding at all to oral antibiotics after 3 days. She was subsequently started on oral steroids, and her symptoms resolved within 48 h. Steroids were tapered without any recurrence after a period of 6 months.