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Ligneous Conjunctivitis
Conjunctivitis Lignosa

Presentation

On presentation to our clinic, her visual acuity was light perception and intraocular pressure was normal. On slit-lamp examination, dense membranes were present on the tarsal conjunctiva bilaterally. [journals.healio.com]

Clinical Presentation: The median age at diagnosis is about 5 years, and patients present with papillary white red lesions of firm consistency. Below is an image of lesions in both eyelids. [images.missionforvisionusa.org]

Two Caucasian females aged 5 years and an 18-month male of north African descent presented with a membranous conjunctivitis, which recurred after surgical excision. [ncbi.nlm.nih.gov]

Small blood vessels were present [Fig. 5]. Histopathological findings were suggestive of ligneous conjunctivitis. [journals.lww.com]

Case presentation A 67-year-old man presented at our Department of Ophthalmology for treatment recommendation of recurrent conjunctival ″granuloma″ in his left eye. [bmcophthalmol.biomedcentral.com]

Eyes

  • Conjunctival Disease

    Discussion Additional studies included corneal sensitivity testing, to rule out chronic conjunctival disease, and eyelid eversion, to rule out superior palpebral conjunctival involvement or scarring. [reviewofoptometry.com]

Treatment

A good response was observed to topical fresh frozen plasma (FFP) treatment without systemic therapy, and the membranes did not recur during the treatment. [aboonline.org.br]

[…] after this period of treatment (Figure 2). [scielo.br]

Various treatments, both systemic and local, were tried without success. The histological diagnosis of ligneous conjunctivitis was not made until 1981. Treatment with the known remedies for ligneous conjunctivitis was not successful. [link.springer.com]

While the initial follow-up will be more frequent, once the treatment is tapered off, these patients are still at risk of recurrence soon after treatment or even many years later. [eyewiki.aao.org]

Treatment with topical plasminogen resulted in prompt resolution of the membranes. Treatment with topical plasmin was ineffective. [ncbi.nlm.nih.gov]

Prognosis

Prognosis The prognosis of ligneous conjunctivitis depends on the ability to control the inflammation and recurrence of the pseudomembranes. [eyewiki.aao.org]

Prognosis The visual prognosis is moderate. Corneal involvement may lead to blindness due to scarring, vascularisation, keratomalacia and perforation. The documents contained in this web site are presented for information purposes only. [orpha.net]

Prognosis: The prognosis for ligneous conjunctivitis is variable and is based upon the extent, length and the affected site producing symptoms. It depends on the ability to control inflammation and recurrence of pseudo-membranes. [aimu.us]

Etiology

With the knowledge of the etiology of ligneous conjunctivitis, efforts are underway to identify the best method of delivery of plasminogen. [ncbi.nlm.nih.gov]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Etiology: Several mutations have been detected in the plasminogen gene of patients affected with ligneous conjunctivitis. [images.missionforvisionusa.org]

Am J Surg Pathol 1987;11:598, Wikipedia: Liesegang rings [Accessed 26 April 2018]) Epidemiology Usually children (median age 5 years), but can occur in adults Sites Unilateral or bilateral Palpebral most common but also limbal and bulbar conjunctiva Etiology [pathologyoutlines.com]

Epidemiology

[…] phenomenon of chemical systems) seen in conjunctiva and eyelid, associated with inflammation, necrosis, fibrosis or cysts May resemble helminth eggs, larvae or adults (Am J Surg Pathol 1987;11:598, Wikipedia: Liesegang rings [Accessed 26 April 2018]) Epidemiology [pathologyoutlines.com]

Summary Epidemiology Prevalence in the general population is unknown but estimates range between 0.13% and 0.42% in healthy subjects with heteterozygous hypoplasminogenemia. More than 200 cases have been reported so far. [orpha.net]

Neurology and Neurosurgery Czech and Slovak Ophthalmology Czech and Slovak Psychiatry Czech Geriatric Review Czech Gynaecology Czech Rheumatology Czech Dental Journal Czech Urology Czech-Slovak Dermatology Czecho-Slovak Pathology Czech-Slovak Pediatrics Epidemiology [prolekare.cz]

Pathophysiology

May 2005 Volume 46, Issue 13 Free ARVO Annual Meeting Abstract | May 2005 Ligneous Conjunctivitis in an Adult Patient: A Study of Molecular Pathophysiology and Treatment Options Author Affiliations & Notes J. [iovs.arvojournals.org]

The pathophysiological mechanism is unclear at present. It is advisable to look for plasminogen deficiency in patients with congenital hydrocephalus, because obstruction of ventriculoperitoneal shunts is possible when such a condition is overlooked. [ncbi.nlm.nih.gov]

General Pathology The histology shows ulcerated conjunctiva with sub-epithelial, amyloid-like, eosinophilic material containing clotted fibrinogen and immunoglobulins, accompanied by lymphocytes, granulocytes, and plasma cells (Figure 1).[1] Pathophysiology [eyewiki.aao.org]

Prevention

Topical FFP treatment may facilitate rapid rehabilitation and prevent recurrence in patients with ligneous conjunctivitis. [aboonline.org.br]

Prophylactic use of topical and subconjunctival fresh frozen plasma may help in the prevention of membranes in susceptible patients with plasminogen deficiency. [ncbi.nlm.nih.gov]

Prevention There is no primary preventive measure for this disease as it is often inherited. [aimu.us]

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