BILATERAL DACRYOADENITIS WITH RHEUMATOID ARTHRITIS: TREATMENT A ND REHABILITATION EXPERIENCE

Dacryoadenitis is an inflammation of the lacrimal gland, the process is more often unilateral, can be both acute and chronic. The resumption of a pathologically chronic process in the lacrimal gland can lead to hypertrophy of the skin of the upper eyelid in the area of the lacrimal gland, which can cause an unpleasant aesthetic defect to the patient. After consultation with an oculoplastic surgeon, it was decided to perform upper blepharoplasty. Due to the combined treatment, the expectations of the doctor and the patient are justified.
The aim of the study was to study the effectiveness of treatment aimed at eliminating inflammatory and edematous processes with improved microhemolymphocirculation and achieving the desired result of the patient - upper blepharoplasty in the presence of rheumatoid arthritis and relapses of chronic dacryoadenitis in the patient's history.
The objective of the study was to assess the result of the combined treatment of chronic autoimmune dacryoadenitis with the achievement of a persistent relapse and the expected cosmetic effect of upper eyelid blepharoplasty. 
Results. The study includes one clinical case in which a 27-year-old patient with a history of systemic chronic joint disease and a long-term autoimmune disease of the tear-producing gland. The main desire of the patient is to achieve a stable recurrence of chronic inflammation of the lacrimal gland and also to get rid of the stretched and overhanging skin of the upper eyelids. The period of our observation was generally 6 months.
As a result of our investigation of this case, we achieved the strengthening and restoration of the normal functioning of the lacrimal gland and fulfilled the patient's wishes to give an aesthetically beautiful appearance to the upper eyelids.
Conclusions. As a result of the combined treatment, we managed to achieve a persistent recurrence of chronic inflammation of the lacrimal gland and achieve the desired cosmetic effect.
A combination of surgical and conservative treatments for chronic diseases of the lacrimal gland, leading to stretching of the skin of the upper eyelid, can become an alternative way of treating dacryoadenitis with the achievement of stabilization of the chronic process and the elimination of an undesirable aesthetic flaw.

1. Rute Lopes Caçola, Sandra Alves Morais, Rui Carvalho, and Rui Môço. Bilateral dacryoadenitis as initial presentation of a locally aggressive and unresponsive limited form of orbital granulomatosis with polyangiitis. Portugal; (25 April 2016) https://pubmed.ncbi.nlm.nih.gov/27170605/.

2. Gabriel Sebastián Díaz-Ramírez, Luis Fernando Medina-Quintero, Alexander Salinas-César, Andrés Felipe Zea-Vera. Dacryoadenitis Associated with IgG4-related Disease in an Afro-Colombian Adolescent. Colombia. (May-June 2018). https://pubmed.ncbi.nlm.nih.gov/27989497/.

3. Matthew Witmer, MD, Tampa, Fla. Unraveling the Difficult Diagnosis of Dacryoadeniti. South Florida. (August 2009) https://www.reviewofophthalmology.com/article/unraveling-the-difficult-diagnosis-of-dacryoadenitis.

4. Oluwatobi O Idowu, Murtaza Saifee, Thomas S Copperman, Robert C Kersten. Dacryoadenitis Associated with Juvenile Idiopathic Arthritis. Korea. (August 2021) https://en.x-mol.com/paper/article/1390934704406548480.

5. James P. Rathmell, Carol L. Shields, Jerry A. Shields, Ralph C. Eagle &Richard D. Gordon. Chronic dacryoadenitis associated with juvenile rheumatoid arthritis. (July 2009). https://www.tandfonline.com/doi/abs/10.3109/01676838809036134.

6. Vinceneux P. Cogan’s syndrome. Orphanet https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5729811/.7. P. Saraiva, S.W. Genders, M.V. Buchem, G.P.M.

7. Luyten & J-W Beenakker. CT and MR imaging of orbital inflammation. Netherlands. (October 2019). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6244997/.

8. Lu X., Wang X., Nian H. et al. Mesenchymal stem cells for treating autoimmune dacryoadenitis. Stem Cell Res Ther 8, 126 (2017). https://stemcellres.biomedcentral.com/articles/10.1186/s13287-017-0593-3.

9. Huang S., Juniat V., Satchi K. et al. Bilateral lacrimal gland disease: clinical features and outcomes. Eye (2021). https://pubmed.ncbi.nlm.nih.gov/34725471/.

10. Kase S., Ishida S. COVID-19-related chronic bilateral dacryoadenitis: a clinicopathological study. JAMA Ophthalmol. Published (February 17, 2022). https://pubmed.ncbi.nlm.nih.gov/35175309/.

11. Krjukov A.S., Revmatodnyj artrit simptomy diagnostiki i lechenie. Sankt-Peterburg. (Ijul' 2018). https://stromynka7.ru/blog/revmatoidnyj-artrit-simptomydiagnostika-i/. (in Russian)

12. Chichasova N.V. Revmatoidnyj artrit: problemy lechenija na sovremennom jetape. Moskva. (2018). https:// cyberleninka.ru/article/n/revmatoidnyy-artrit-problemylecheniya-na-sovremennom-etape/viewer. (in Russian)

13. Zubkova E.A. Dakrioadenit - simptomy i lechenie. (fevral' 2021). https://probolezny.ru/dakrioadenit /. (in Russian)

14. Fedorov S.N., Jarceva N.S., Ismankulov A.O. Glaznye bolezni. Moskva (2005). (in Russian)

15. Ismailova D. S, Grusha Ja.O., Abramova Ju.V., Novikovz P.I., Danilov S.S., Klinicheskie projavlenija porazhenija orbity pri granulematoze s poliangiitom. Moskva. (2018). (in Russian)

16. Kim A.R., Chemeris M.V. Revmatoidnyj artrit. Sankt-Peterburg. - (2021). (in Russian)

17. Apostolos Kontzias, MD, Stony Brook University School of Medicine. - May 2020. (in Russian)

18. Nogaeva M.G., Amanzholova A.S., Primenenie genno-inzhenernoj biologicheskoj terapii u bol'nyh revmatoidnym artritom v Respublike Kazahstan. Almaty. - 2015. (in Russian)

19. Grunina E.A., Vinogradova N. A, Klinicheskoe uluchshenie i predotvrashhenie kostno-hrjashhevoj destrukcii pri lechenii revmatoidnogo artrita nizkimi dozami gljukokortisteroidov. Nauchno-prakticheskaja revmatologija. - 2000. https://doi.org/10.14412/1995-4484-2000-186. (in Russian)

20. Nemcov B.F., Simonova O.V., Benenson E.V., Politova N.N. Kombinirovannaja terapija prospidinom i metotreksatom bol'nyh revmatoidnym artritom (12-mesjachnoe kontroliruemoe issledovanie). Medicinskaja akademija g. Kirov. Klinika vnutrennih boleznej №1 Kel'nskogo universiteta, Germanija. - 2003. (in Russian).