Lacrimal gland swellings

Swelling(s) of the lacrimal gland usually presents as mass(es) in the upper lateral margin. A common cause of 
bilateral lacrimal swellings is sarcoidosis, the patient is usually of African or Afro-Carribean origin. 

There are bilateral swellings of the lateral orbital margin. Palpation reveals firm masses which are not mobile.

Look for signs of sarcoidosis:

  • skin nodules on the lids (from sarcoid infilatration) or purple-red infiltration of the nose (lupus pernio)
  • examine the anterior segment for dry eyes and anterior uveitis
  • if the pupil were dilated, look for any signs of vasculitis which is typically described 'candle-wax'
  • palpate the parotid glands for enlargement and examine the mouth for dry mouth (Mikulicz's syndrome)


1. What is Mikulicz's syndrome?

2. What is the differentiate diagnosis of a patient with bilateral lacrimal gland swelling?

3. Below are two chest X-ray of two patients with sarcoidosis. What do they show?



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Sarcoid nodules involving the medial aspect of the upper lid
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Lupus pernio. Note the purpurlish infiltration of the nose
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Vasculitis in sarcoidosis. Note the candlewax appearance of the retinal vessels.
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