Bilateral symmetrical enlargement of Lacrimal Glands

Causes of bilateral symmetrical enlargement of lacrimal glands include:

1. Sarcoidosis. (Usually associated with systemic sarcoidosis. Rare to have isolated lacrimal gland involement).
2. Lymphoma.
3. Leukemia.
 
Lymphomatous involvement of lacrimal glands usually shows restricted diffusion in MRI.

4. Sjogren Syndrome (autoimmune condition affecting salivary and lacrimal glands, F:M ratio of 9:1, seen in 4th and 5th decades of life, Early stages glands can become enlarged, to atophy in the later stages).


Less common causes of symmetrical lacrimal gland enlargement include:

5.  Mikulicz syndrome - Previously considered as a subtype of Sjogren, now being considered as a part of IgG4 related disease spectrum.

6. Kimura disease - usually presents as painless enlargement of neck lymph nodes and salivary glands, with associated blood eosinophilia, raised serum IgE, associated soft tissue masses. Affects males of 20-40yrs in 80% of cases.

7. Primary Lacrimal Amyloidosis.


Lacrimal glands measures ~4-5mm usually. A visual / subjective assessment is usually sufficient for making the diagnosis of enlargement.




References:
1. Lacrimal Glands: Size Does Matter!, Middle East Afr J Ophthalmol. 2011 Oct-Dec; 18(4): 328–330.
2. Radiopaedia.