Bacterial Dacryoadenitis With Abscess: Meta-Analysis of Features and Outcomes of a Rare Clinical Entity

Bacterial dacryoadenitis with abscess is rare. There is limited evidence examining the clinical course, and there is no consensus on evidence-based management protocols. The authors aim to systematically review the current literature on bacterial dacryoadenitis with abscess, examining etiology, clinical and radiological features, management, and outcomes.

A systematic search of the databases PubMed/MEDLINE, Embase, and CENTRAL was performed to July 2024, prior to data collection and risk of bias analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Twenty-five articles met the inclusion criteria. Fifty-one cases of bacterial dacryoadenitis complicated by abscess were identified, mean age 34.5 ± 22.3 years including n = 17 females (40.4%, subgroup with full demographic data, n = 42). Methicillin-sensitive Staphylococcus aureus was identified as the most common causative organism (25.4%), followed by methicillin-resistant Staphylococcus aureus (17.9%) and Haemophilus influenzae (12.8%). Clinical features included upper eyelid swelling (74.5%) and pain (39.2%), along with extraocular movement restriction (58.8%), gaze-evoked pain (39.2%), erythema (45%), chemosis (41.1%), and lacrimal gland protrusion (19.6%). A well-defined, rim-enhancing lesion within an enlarged lacrimal gland was typical on imaging (seen in 33.3%). The majority were managed with abscess drainage with concurrent intravenous antibiotics (66.6%). Only 1 patient among the included studies suffered a recurrence. Abscess drainage was not associated with patient age ( p = 0. 8) or with Staphylococcus aureus as the causative organism ( p = 0.7).

Bacterial dacryoadenitis with abscess is a rare but potentially sight-threatening entity. Requirement for abscess drainage in bacterial dacryoadenitis was not associated with patient age, nor with the most common causative bacteria. Clinicians should be aware of the potential for compressive optic neuropathy, and alert to signs that may indicate surgical drainage, in particular, inadequate response to antibiotics.