IgG4-Related Chronic Sclerosing Dacryoadenitis

dilated fundus examination findings were normal. Blood studies were negative for antinuclear antibodies and rheumatoid factors and showed a normal complete blood count and negative angiotensin-converting enzyme levels. We diagnosed bilateral atypical Cogan syndrome in the patient. The bilateral iritis resolved with cycloplegics and topical steroid drops. The patient has been referred for a cochlear implant. He had another episode of bilateral iritis 3 months later, which also resolved with topical cycloplegic and steroid eye drops. Case 2. A 10-year-old white boy had a history of bilateral red eyes for 1 month at initial examination. One year prior to this eye examination, he had acutely lost all of his hearing and had undergone a cochlear implant in his right ear. Visual acuity was 20/30 OD and 20/20 OS. He had bilateral iritis with posterior synechiae in the left eye. There were no corneal lesions and the dilated fundus examination findings were normal. Blood studies were performed and levels of rheumatoid factor, fluorescent treponemal antibody absorption, angiotensin-converting enzyme, and complete blood count were all normal. The iritis resolved quickly with topical dilating and corticosteroid drops. Six months later, the patient had another episode of bilateral iritis without corneal inflammation, which also resolved with topical drops. At the 2-year follow-up, there was no recurrence. Case 3. A 13-year-old white boy had a history of red eyes off and on for the past 2 years, which were treated with topical antibiotic drops. He had lost all hearing acutely during a 2-week period 18 months previously. He had received a successful left cochlear implant. Visual acuity was 20/30 OU and bilateral iritis was present. There were no corneal lesions and the dilated fundus examination findings were also normal. Blood tests showed that levels of fluorescent treponemal antibody absorption, rheumatoid factor, complete blood cell count, and angiotensin-converting enzyme were all normal. The iritis resolved with topical cycloplegic and steroid drops. The patient had 1 recurrent episode of bilateral iritis 4 months later and now has been clear for 2 years.