Sarcoidosis of the Lacrimal Gland
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The lacrimal gland is the second of the orbital
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appendages after the lacrimal sac.
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The lacrimal gland may be involved by any number of
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diseases, and we usually separate them into epithelial
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lesions, versus lymphoproliferative lesions
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versus congenital lesions.
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Let's start with the lymphoproliferative lesions
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and/or granulomatous diseases. In this case,
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we have a patient who has sarcoidosis.
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And what I see, in the evaluation of this patient,
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is enlargement of the left lacrimal gland,
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compared to the normal position and size of the right
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lacrimal gland.
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It has heterogeneous density to it.
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This is noted here,
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laterally in the left side of the orbit.
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Sarcoidosis most commonly affects the uveal tract, which,
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as you recall, includes the ciliary body, the iris,
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and the choroid.
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However, the next most common involved organ of
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the orbit is the lacrimal gland.
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Sarcoidosis may also affect the extraocular muscles and
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cause enlargement, and it also may cause sinusitis.
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And therefore, involvement of the extraconal space.
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You note that, in this case, the inflammation from the
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lacrimal gland extends to the superior
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orbit and into the intraconal space.
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This is another of the complications of sarcoidosis in the orbit,
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where one can have infiltration of the retrobulbar fat.
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
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