Spontaneous filtration bleb as a consequence of scleritis.

logical findings of IgG4-related disease irrespective of the organ of origin. However, hyalinized dense fibrosis as observed in cases 1 and 2 is not typical for IgG4-related diseases to our knowledge. We speculated that this difference might depend on anatomical characteristics of the lacrimal gland (eg, tightly surrounded by muscles and bone) or the duration of this disease. In addition, it is interesting that acinar subunits were considerably atrophied, although no patients showed lacrimal dysfunction such as keratoconjunctivitis sicca. Similarly, pancreas with autoimmune pancreatitis usually shows normal exocrine pancreatic function irrespective of acinar atrophy. This discrepancy has not been well documented until now, and further pathophysiological examinations are mandatory for this issue. In all of the cases, we performed unilateral resection of the lacrimal gland to make a diagnosis. However, surgery was also intended as part of the treatment in case 2 because steroid therapy was undesirable for the patient’s diabetes mellitus. The left eyelid swelling, his chief symptom, improved after surgery. Thus, excisions of enlarged lacrimal glands (occasionally bilateral) may be an alternative treatment for Mikulicz disease when steroid treatment is undesirable. In conclusion, the 4 cases of Mikulicz disease reported here had chronic sclerosing inflammation of the lacrimal gland with IgG4stained plasma cell infiltration. These findings support the theory that Mikulicz disease is within the clinical spectrum of IgG4-related sclerosing diseases.