Algorithm of Wright et al for the Diagnosis of a Lacrimal Gland Tumors

A mass in the fossa of the lacrimal gland may be caused by a number of processes. The diagnosis requirs a careful patient assessment.

Differential diagnosis of a lacrimal gland mass includes:

(1) infection

(2) other inflammatory condition

(3) benign tumor or cyst

(4) malignant tumor (malignant mixed cell, adenoid cystic, other)

Presentation of a benign mixed tumor: painless, slow progression, pressure changes on X-ray

Presentation of a malignant tumor: pain, rapid progression, destruction on X-ray

Parameters:

(1) duration of symptoms

(2) X-ray findings

(3) clinical findings

(4) response to antibiotic therapy

Duration	X-Ray	Clinical	Response to Antibiotics	Diagnostic Approach
< 12 months	normal	inflammatory	improved without mass	observe
< 12 months	normal	inflammatory	mass	incisional biopsy if does not regress
< 12 months	normal	without inflammatory changes	NA	incisional biopsy
< 12 months	pressure changes	NA	NA	incisional biopsy
< 12 months	destructive changes	NA	NA	incisional biopsy
>= 12 months	normal	NA	NA	en bloc excision
>= 12 months	pressure changes	NA	NA	en bloc excision
>= 12 months	destructive changes	NA	NA	incisional biopsy

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