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Ligneous conjunctivitis: a case report
First Author: D. Dimopoulos GREECE
Co Author(s): A. Zacharioudakis P. Koutentakis M. Koutentaki G. Kazamias V. Danilatou M. Nodarakis
To report a 36 years old female patient with ligneous conjunctivitis.
A 36-year-old female presented at the ophthalmology department with complaints of redness, irritation, and appearance of membraneous lesions mainly on the tarsal conjunctivae .There was periodically existence of membranes in other parts of the body as oropharynx, female reproductive tract and gingiva. There is no history of eye trauma.
The lesion was gently peeled off from the mucosal surfaces meticulously and minimal bleeding was noted after the removal, which was controlled with pressure mops. The underlying tarsal conjunctiva was healthy with no evidence of necrosis. The removal was done under topic anesthesia. The diagnosis of ligneous conjunctivitis was certified by histopathological examination and by coagulation analyses which revealed decreased plasminogen activity (<2%; normal 75ﾖ150%). It was treated with topical fresh frozen plasma (FFP), topical steroids, heparin eye drops and artificial tear drops daily, without systemic therapy. The therapy was continued for 3 months postoperatively.
There was no recurrence of the membranes at the end of 12-months follow-up.
Systemic plasminogen deficiency has been linked to ligneous conjunctivitis. The treatment is extremely difficult and it is not standardized. Surgical excision of pseudomembranes is frequently followed by rapid regrowth of the membranes and is believed to be by itself a trigger for recurrences. Other treatment approaches include topical and subconjunctival fresh frozen plasma (FFP), administration of standard heparin in combination with topical corticosteroids or alpha-chymotrypsin, and topical (or systemic) application of immunosuppressive drugs. In our case, topical treatment with FFP , topical steroids, heparin eye drops and artificial tear drops daily, without systemic therapy facilitated rapid recovery and prevent recurrence.
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