Mikulicz's disease and Sjogren's syndrome

PURPOSE. TO characterize lacrimal gland function and lymphocyte infiltratio n in patients with Mikulicz's disease (MD) and Sjogren's syndrome (SS). METHODS. Four patients with MD and 5 with SS were recruited, on whom were p erformed Schirmer test I (Schirmer test without anesthesia), Schirmer test with nasal stimulation, and vital staining of the ocular surface. The lacri mal gland was then biopsied and the tissues stained with CD3, CD4, CD8, B22 0, APO2.7, Fas, and Fas ligand (Fas-L) antibodies. RESULTS. Although regular Schirmer test results in the MD group were less t han 10 mm, those with nasal stimulation, 38.1 +/- 3.4 mm, were significantl y greater than the SS group. There were minimal ocular surface changes in M D. Morphologic staining with hematoxylin and eosin was identical in both gr oups, but the acinar cells were stained with APO2.7 only in the SS group. T here was strong Fas and Fas-L staining in SS patients but not in those with MD. CONCLUSIONS. Lacrimal gland acinar cells in those with MD maintained their function and were not programmed for cell death. The sicca syndrome was not observed in MD patients. Although the pathology is similar for MD and SS, the difference in acinar cell apoptosis and function can explain clinical d ifferences.