“ This affects adults and is due to lymphocytic infiltration. It causes a painful, proptosed and paralysed eye. The lacrimal gland is the mo...
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This affects adults and is due to lymphocytic infiltration. It causes a painful, proptosed and paralysed eye. The lacrimal gland is the most frequently affected. It is associated with retroperitoneal fibrosis, Wegener granulomatosis, sarcoidosis and fibrosing mediastinitis. It may affect other parts of the skull base, meninges, nasopharynx, etc. The main differential is lymphoma. A response to steroids suggests pseudotumour.
Tolosa-Hunt syndrome is a variant of pseudotumour extending through the superior orbital fissure to the cavernous sinus, producing painful ophthalmoplegia (palsy of III, IV, V and VI)
The lacrimal gland is involved in 5% of cases of pseudotumour.
MRI
• Low signal mass on T2 (due to fibrosis, tumours are usually high signal on T2)
• Diffuse enhancement
• Sparing of the tendinous insertions of the extraocular muscles
• 85% unilateral
Post-contrast CT scan of the orbits showing asymmetrical enlargement of the left lacrimal gland (white arrow) in a patient with known sarcoidosis. A basic knowledge of orbital anatomy will help narrow the differential
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