Bilateral Idiopathic Dacryoadenitis in an Infant: A Case Report and Review of the Literature.

Dacryoadenitis is most commonly caused by infectious, inflammatory or neoplastic processes. Idiopathic dacryoadenitis is exceptionally rare in children. We present a case of a 22-month-old previously healthy boy with progressive bilateral eyelid swelling, conjunctival chemosis and ocular discharge without systemic features. He was initially treated for atypical conjunctivitis but failed antimicrobial therapy and continued to deteriorate clinically. Investigations including bacterial swabs, viral serology and autoimmune testing were negative. Magnetic resonance imaging demonstrated bilateral lacrimal gland enlargement. Lacrimal gland biopsy revealed chronic lymphoplasmacytic inflammation without vasculitis or increased IgG4-positive plasma cells. The patient was diagnosed with idiopathic dacryoadenitis and responded rapidly to systemic corticosteroids, with complete resolution within 3 weeks. This case highlights the diagnostic challenge of paediatric dacryoadenitis and the importance of early imaging and tissue diagnosis in atypical or progressive cases.