Asymmetric lacrimal gland enlargement: an indicator for detection of pathological entities other than thyroid eye disease

  • Eri Ishikawa
  • Yasuhiro TakahashiEmail author
  • Ma. Regina Paula Valencia
  • Marian Grace Ana-Magadia
  • Hirohiko Kakizaki
Oculoplastics and Orbit



To examine the clinicopathological characteristics of patients with thyroid eye disease (TED) who showed asymmetric lacrimal gland enlargement.


Sixteen patients were included in this retrospective, observational case series. The following data were collected: sex, age, laterality, past medical history, laboratory results for thyroid function and other autoimmune disorders, pathological results, other systemic lesions related to lacrimal gland pathology, and the clinical course after treatment.


The results of pathological examinations were consistent with non-specific dacryoadenitis in seven patients, immunoglobulin G4-related dacryoadenitis in four patients, sarcoidosis in two patients, and xanthogranuloma in one patient, respectively. The remaining two patients were proven to be extra-nodal marginal zone lymphoma of mucosa-associated lymphoid tissue type (MALT lymphoma). One patient with sarcoidosis was noted to have another related systemic lesion. After treatment or observation, the lesions were either improved or stable in almost all patients, except for the two patients with MALT lymphoma.


Patients with TED who present with asymmetric lacrimal gland enlargement need to be further evaluated. Biopsy of the lacrimal gland and full systemic work-up should be considered as these may lead to detection of other pathological entities, especially malignancies, which could help in saving patients’ lives.


Thyroid eye disease Asymmetric enlargement Lacrimal gland Malignancy 



Part of this study was presented at the 41th annual meeting of the Japanese Society of Ophthalmic Surgery on January 27, 2018. The authors wish to acknowledge Dr. Makoto Ito at Department of Radiology, Aichi Medical University, for assisting the authors in the interpretation of imaging studies.

Compliance with ethical standards

Conflicts of interest

The authors have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethics approval and informed consent

The institutional review board (IRB) of Aichi Medical University Hospital approved this retrospective, observational study (no. 17-H053); in addition, the study was conducted in accordance with the tenets of the Declaration of Helsinki and its later amendments. The IRB granted a waiver of informed consent for this study based on the ethical guidelines for medical and health research involving human subjects established by the Japanese Ministry of Education, Culture, Sports, Science, and Technology; and by the Ministry of Health, Labour, and Welfare. The waiver was granted because the study was a retrospective chart review, not an interventional study, and because it was difficult to obtain consent from patients who had been treated several years previously. Nevertheless, at the request of the IRB, we published an outline of the study on the Aichi Medical University website that was available for public viewing; this also gave patients the opportunity to refuse to participate in the study, although none did. Personal identifiers were removed from the records prior to data analysis.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Oculoplastic, Orbital, and Lacrimal SurgeryAichi Medical University HospitalNagakuteJapan

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