Lacrimal Gland Dacryolithiasis With Secondary Bacterial Dacryoadenitis: Clinicoradiological Characterization and Review of Literature

We report a unique case of a 32-year-old woman with a 4-day history of painful right lacrimal gland swelling. MRI demonstrated enhancement and enlargement of the right lacrimal gland. There were nonenhancing, intraglandular foci, with low signal on T2-weighted sequences and marked restricted diffusion. Surgical excision revealed multiple dacryoliths centered on an impacted eyelash. Microbiological evaluation yielded Streptococcus pneumoniae and histopathology confirmed noncalcified ductal dacryoliths with a background of acute inflammation. At 1-month follow-up, symptoms completely resolved with no evidence of recurrence. Lacrimal gland dacryolithiasis is rare and usually presents as refractory conjunctivitis or a chronic lateral conjunctival or canthal mass, rather than acute dacryoadenitis. This case expands the clinicoradiological spectrum of this rare entity and highlights novel MRI patterns that may aid preoperative diagnosis and timely management.