Introduction:

Ligneous conjunctivitis, also known as membranous conjunctivitis or pseudomembranous conjunctivitis, is an uncommon and fascinating ocular disorder characterized by the formation of woody, fibrinous pseudomembranes on the conjunctival surfaces. This condition typically affects young children and can lead to various complications if not promptly diagnosed and managed. In this article, we will explore the clinical features, causes, diagnosis, and treatment of ligneous conjunctivitis.

1. Clinical Features:

Ligneous conjunctivitis manifests as thick, fibrin-rich pseudomembranes that adhere tightly to the palpebral conjunctiva, causing a woody appearance. These pseudomembranes may recur even after removal, and the condition often affects both eyes asymmetrically. In addition to the conjunctival involvement, ligneous conjunctivitis can also affect other ocular surfaces, such as the cornea, leading to corneal opacification and visual impairment.

2. Causes and Associations:

Ligneous conjunctivitis is primarily associated with a deficiency of plasminogen activators, specifically plasminogen activator inhibitor type 1 (PAI-1). This deficiency results in impaired fibrinolysis and excessive fibrin deposition on the conjunctival surfaces. In many cases, the condition is secondary to systemic plasminogen deficiency, which can also affect other mucosal surfaces, such as the respiratory and genital tracts.

3. Diagnosis and Evaluation:

Diagnosing ligneous conjunctivitis involves a comprehensive ophthalmological examination, including a detailed history, slit-lamp biomicroscopy, and conjunctival evaluation. Laboratory tests to measure plasminogen activity and levels may be necessary to confirm the diagnosis and identify any systemic involvement. In some cases, genetic testing may be indicated to identify underlying genetic mutations associated with the disorder.

4. Treatment and Management:

The management of ligneous conjunctivitis aims to remove the pseudomembranes, improve ocular surface health, and prevent recurrence. Treatment strategies may include:

• Surgical removal of the pseudomembranes under anesthesia.
• Topical application of fibrinolytic agents, such as plasmin or tissue plasminogen activator (tPA).
• Systemic administration of plasminogen concentrate or fresh frozen plasma in cases of systemic plasminogen deficiency.
• Long-term use of topical lubricants and anti-inflammatory medications to maintain ocular surface health.

5. Prognosis and Follow-up:

The prognosis for ligneous conjunctivitis varies depending on the severity of the condition, the extent of ocular involvement, and the underlying systemic cause. Early diagnosis and prompt treatment are crucial to preventing vision-threatening complications and achieving better outcomes. Regular follow-up visits with an ophthalmologist and, if necessary, a hematologist or geneticist are essential to monitor the response to treatment and manage any systemic aspects of the condition.

Conclusion:

Ligneous conjunctivitis is a rare and intriguing ocular disorder characterized by the formation of woody pseudomembranes on the conjunctival surfaces. Prompt diagnosis and appropriate management are crucial to preventing complications and preserving ocular health. Understanding the underlying plasminogen deficiency and its association with ligneous conjunctivitis is essential for providing targeted treatment and long-term care.

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