PMC4899634_01
a Acute presentation with a right partial ptosis. b Axial CT scan image showing an enlarged right lacrimal gland with no bony changes. c, d Haematoxylin and eosin staining of right lacrimal gland biopsy (x20 and x40 magnification, respectively) showing destruction of lacrimal gland tissue with some duct preservation, extensive fibrosis and lymphoplasmocytic infiltration. e Immunoperoxidase staining (x40 magnification) showing IgG4-positive plasma cells.
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F1
There was a right 2-mm upper lid ptosis with suspected mild anisocoria (fig. 1a), with a slightly larger right pupil and restriction of the right eye in upgaze. A CT angiogram of the head and neck did not reveal any intracranial abnormality nor any signs of lymphadenopathy or salivary gland involvement; however, it demonstrated right lacrimal gland enlargement (fig. 1b). Immunohistochemistry showed IgG4-positive plasma cells and marked collagen sclerosis (fig. 1c-e).