Neonatal Lacrimal Gland Inflammation: Signs, Causes and Treatment Methods

The eyes are very important in every child’s life. They are one of the primary avenues through which they observe and learn from the world around them and therefore any problem concerning the eyes should be treated promptly and carefully.

The lacrimal glands are vital parts of the eye and perform the important function of producing tears. The lacrimal gland is made up of two visible parts which are the palpebral lobe and the orbital lobe.

Inflammation of this gland leads to red, itchy, and teary eyes, which is always a cause for concern in parents. So you may be wondering; what is neonatal lacrimal gland inflammation? What are the types? What are the symptoms? How can it be treated? All of these questions and more will be answered in the following article.

What is Neonatal Lacrimal Gland Inflammation?

Neonatal lacrimal gland inflammation is a common eye disease that affects the external part of the eye. It occurs when the lacrimal gland gets inflamed, usually when there are not enough secretions in the gland. When a baby is born, the lacrimal duct from which tears flow out is closed by a membrane. As tears begin to form 3-4 weeks after birth, this membrane will automatically burst open for the tears to flow.

However, some babies seem to either have thicker membranes, an extremely narrow duct, or a deformity in the tissue that separates the nose and eyes. These deformities and obstructions contribute to the accumulation of tears in the lacrimal sac. This accumulation makes the lacrimal sac humid and a suitable environment for microorganisms to grow. These microorganisms begin to grow, thereby causing infections in the lacrimal gland and turning the accumulated tears into pus.

In most cases of neonatal lacrimal gland inflammation, obstruction of the tear duct (dacryocystitis) seems to be involved. Dacryocystitis may be chronic or acute. If it is involved, the baby will experience chronic conjunctivitis and there might be the formation of a lacrimal sac fistula.

What are the Causes of Neonatal Lacrimal Gland Inflammation?

Neonatal lacrimal gland inflammation which is also known as dacryoadenitis has several causative agents. The causes are not so wide-ranged and they can be:

• Infectious
• Idiopathic
• Autoimmune
• Lymphoproliferative

Infectious

Infections seem to be the major cause of neonatal lacrimal gland inflammation. If the lacrimal gland is inflamed by infections, the inflammation is acute. These infections can either be caused by viruses, bacteria, fungi, or protozoa.

Inflammation caused by viruses is the most popular. The viruses that can be involved include:

• Epstein-Barr
• Mumps virus
• Adenovirus
• Herpes zoster virus
• Herpes simplex virus
• Rhinovirus
• Coxsackievirus
• Echovirus

Though it is more a more severe condition, a bacterial infection of the lacrimal duct is not as common as viral causes. However, common bacteria that can be involved include:

• Staphylococcus aureus
• Streptococcus
• Moraxella
• Treponema palladium
• Micrococcus
• Diphtheroid
• Borella burgdorferi
• Mycobacterium tuberculosis
• Neisseria gonorrhoeae
• Haemophilus influenza
• Klebsiella pneumonia
• Pseudomonas
• Mycobacterium leprae

Although fungi can be a causative agent of inflammation of the lacrimal gland, it is a very rare occurrence. The fungi that can be involved include:

• Histoplasmosis
• Blastomycosis

However, the case of protozoa causing this infection is extremely rare. Because it is rare, only one form of protozoa has been recorded to cause lacrimal gland inflammation. This protozoan is acanthamoeba.

Idiopathic

This causative agent works on both the infection part and the autoimmune disease part. However, the infection which causes it and the autoimmune disease which it signifies is unknown. It makes the lacrimal gland inflamed, and also causes fibrosis in the gland. It is a very common cause of neonatal lacrimal gland inflammation.

Autoimmune

Sometimes, lacrimal gland inflammation might be a symptom of an underlying autoimmune disease. This might be the only symptom the disease might present until complications begin to occur. The autoimmune diseases that can have lacrimal gland inflammation as a symptom include:

• Sarcoidosis
• Sjorgen syndrome
• Wegner granulomatosis (granulomatosis with polyangiitis)
• Immunoglobulin G4-related (lgG4) autoimmune disease
• Although very rare, lymphoplasmacytic lymphoma also shows lacrimal gland inflammation as a symptom.
• These autoimmune diseases usually show lacrimal gland inflammation as an early symptom.

Lymphoproliferative

Lymphoproliferative causes may lead to lesions in lymph nodes and other tissues. It mostly affects the eyes, thereby affecting the lacrimal gland. It causes neonatal lacrimal gland inflammation by causing tumors in the lymph nodes of the lacrimal gland. This makes the lacrimal gland swell and gets inflamed.

What Are the Types of Neonatal Lacrimal Gland Inflammation?

This inflammation can be of two different types. Both types of neonatal lacrimal gland inflammation are to be treated immediately symptoms are noticed, although they have different causes and intensities of pain felt. The types of neonatal lacrimal gland inflammation are:

• Chronic lacrimal gland inflammation
• Acute lacrimal gland inflammation

Chronic Lacrimal Gland Inflammation

This is the most common form of neonatal lacrimal gland inflammation. It is not caused by infections and it is not that painful. It just has a major symptom of dryness of the eyes and swelling of the lacrimal gland. It is caused by thyroid eye diseases, overgrowth of inflammatory cells (sarcoidosis), and the swelling of the tissue behind the eye, in the orbit (orbital pseudotumor).

Acute Lacrimal Gland Inflammation

Acute lacrimal gland infection is caused by bacteria, viruses, fungi, or protozoa. These infections can be mumps, staphylococcus, gonococcus, or Epstein-Barr virus. Acute lacrimal gland inflammation is temporary and quite easy to treat but is quite painful. It usually comes with an upper respiratory tract disease.

What Are the Symptoms Of Neonatal Lacrimal Gland Inflammation?

For parents to be able to identify the symptoms of neonatal lacrimal gland inflammation on time, they should be very aware that babies do not produce tears immediately after birth. Production of tears in newborns occurs 1-2 months after childbirth. Therefore, if the baby seems to have teary eyes together with redness and eczema around the eyes within this period, the baby might have neonatal lacrimal gland inflammation. Another immediate symptom that might be seen immediately after birth is when the baby cries out sticky yellow and white pus. This crying baby also has a red and swollen lacrimal gland at the corner of his eyes which when pressed gently produces yellow and white pus in a large amount. The baby also finds it difficult to make eye movements and the child seems to always be in pain.

How can Neonatal Lacrimal Gland Inflammation Be Treated?

Immediately these symptoms are observed, it is most advisable to take the baby to the hospital for proper examination. This is so that the extent of the inflammation can be observed for accurate treatment (which includes surgery) to be given. However, during treatment, most doctors advise nursing mothers to massage the lacrimal gland as part of the treatment.

Proper knowledge of how to give a lacrimal gland massage, how long it should be given, and what to watch out for during the massage can lead to faster improvement.  The lacrimal sac is beside the nose, just outside the eyes. Use your thumb to massage this area, apply pressure during the massage. Make sure the lacrimal sac moves up and down as this means that it is been massaged. Do 5-6 rounds of this 2-4 times a day. This massage is to be given for a whole month. Ensure to gain permission from a doctor before carrying out a massage of the lacrimal gland.

Accompanying the massage is an antibiotic eye drop that is prescribed by a doctor. This eye drop should be given 3-4 times a day. 1-2 drops are to be given to the eye whose lacrimal gland was inflamed.

If after one month of massage and antibiotic treatment if the situation does not improve, take the baby to a hospital. This is because if treatment is not given the other tissues around the lacrimal sac will get inflamed or they will form fistulas which are not easy to cure. If the baby is taken to the hospital, minor surgery is conducted. This surgery which involves the lacrimal duct being probed is a low-risk surgery in which the baby does not need to be hospitalized.

In Conclusion

Neonatal lacrimal gland inflammation is a common external eye disease, which should be treated promptly to avoid complications from occurring in the long run. The lacrimal gland is not fully developed in newborns until 6 months after childbirth. Therefore, all forms of treatment given must be conservative and given with extreme caution under the guidance of a medical doctor. Scars that are irreversible and which might threaten the child’s beauty will also occur if caution is not taken during treatment, or an inappropriate treatment was given.

Parents should endeavor to act immediately after lacrimal gland inflammation is noticed. It is a common disease and also may be an indication of other autoimmune diseases. Therefore lacrimal gland inflammation should be treated on time to prevent dysfunction of the lacrimal gland, avoid the infant from developing ocular complications in the future and identify and treat other autoimmune diseases as quickly as possible.

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