Ligneous conjunctivitis
What is it?
Ligneous conjunctivitis is a rare form of chronic conjunctivitis characterized by the recurrent development of pseudo-membranous lesions of a woody consistency, rich in fibrin and firmly anchored to the tarsal conjunctiva. It is very often described as the clinical symptom of severe compound heterozygous and homozygous hypoplasminogenemia. The prevalence in the general population is unknown but estimated to be between 0.13% and 0.42% in healthy subjects with heterozygous hypoplasminogenemia.
Causes and risk factors
In predisposed individuals, ligneous conjunctivitis can be caused by local lesions, systemic or local infections, and various types of eye surgery.
Which are the symptoms?
The disease is characterized by chronic fissures and reddening of the conjunctiva, resulting in the formation of fibrin-rich pseudomembranes.
Pseudomembranes usually form on the superior tarsal conjunctiva, although involvement of the lower eyelid and bulbar conjunctiva has been reported. The lesions develop into red, white, or yellowish-white masses, similar in consistency to wood, which replace the normal conjunctival mucosa. The disease is bilateral in about half of cases, and corneal involvement is present in about one third of cases. Woody conjunctivitis is an ocular symptom of a systemic disease and is often associated with lesions of the mucous membranes of the mouth, nose-pharynx, tracheobronchial tree, intestines, kidneys, female genital tract, and ears.
How is it treated?
Eye lesions can be treated with topical therapy: human plasminogen for topical administration, administration of fresh frozen plasma for topical administration, administration of heparin in combination with corticosteroids or topical alpha-chymotrypsin, and local (or systemic) administration of immunosuppressants (cyclosporin A, azathioprine). Surgical excision of pseudomembranes and other mechanical manipulations with the eye should be avoided. No visual forecast needed. Corneal damage can lead to cicatricial blindness, vascularization, keratomalacia, and perforation.
Where do we treat it?
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