Figure 4: An unrelated case with symptoms similar to orbital IgG4-related disease. This 71-year-old woman had a 6-month history of swelling of both upper eyelids. Computed tomography showed an enlargement of both lacrimal glands. Histology and immunohistochemistry showed reactive lymphoid hyperplasia without IgG4-positive plasma cells. The woman had normal level of IgG4 (57 mg/dL) and an indolent clinical course for two years without treatments.