Eye
Conjunctiva
Conjunctivitis
Ligneous conjunctivitis
Author: Deepali Jain, M.D.
Last author update: 1 October 2014
Last staff update: 19 May 2022
Copyright: 2004-2024, PathologyOutlines.com, Inc.
PubMed Search: Ligneous conjunctivitis [title]
Table of Contents
Definition / general | Terminology | Epidemiology | Sites | Etiology | Clinical features | Laboratory | Case reports | Treatment | Clinical images | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Electron microscopy images | Differential diagnosis | Additional referencesCite this page: Jain D. Ligneous conjunctivitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/eyeconjligneous.html. Accessed April 25th, 2024.
Definition / general
- Chronic relapsing pseudomembranous conjunctivitis with woody induration of eyelid and tarsal conjunctiva and pseudomembrane on tarsal conjunctiva
- Also affects other mucosa
Terminology
- "Ligneous" means resembling wood
- Liesegang rings:
- Rings of precipitated iron and calcium (a 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
- 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
- Due to mutations in plasminogen PLG gene at 6q26 / plasminogen deficiency (J Thromb Haemost 2007;5:2315)
- Autosomal recessive
- Triggered with external irritants, fever, antifibrinolytic therapy and ocular surgery
Clinical features
- Mild discomfort with redness, woody induration of conjunctiva
- Similar lesions in mouth and upper respiratory tract, female genital tract or other mucosal surfaces
- May threaten sight
- Pseudomembrane typically separates from underlying epithelium without bleeding
- Corneal scarring, vascularization, infection or melting in advanced cases
Laboratory
- Decreased serum level of plasminogen type I
Case reports
- 7 month old boy with "sticky eye" (Digital Journal of Ophthalmology 2006;12(3))
- 20 year old woman with prosthetic eye (Int Ophthalmol 2011;31:25)
- 27 year old woman with Crohn's disease (Clin Ophthalmol 2008;2:203)
Treatment
- Excision, but pseudomembrane recurs (Virchows Arch 2007;451:815)
- Topical and systemic FFP treatment and conjunctival membrane excision (Cornea 2008;27:501)
- Topical or systemic plasminogen
- Topical heparin and steroids
Clinical images
Images hosted on other servers:
Plaque like ulceration
Elevated hard mass
Gross description
- Woody accumulation of fibrin
Microscopic (histologic) description
- Membrane contains large hyaline masses of fibrin and immunoglobulin but resembling amyloid
- Also T cells and B cells
- Conjunctival epithelium is thin and replaced focally with necrotic tissue
- Pink eosinophilic amorphous material within subepithelial tissue mimics amyloid
Microscopic (histologic) images
Images hosted on other servers:
Eosinophilic deposits surround islands of epithelial cells
Eosinophilic hyalinized tissue with inflammation
Histopathology of conjunctival biopsies
Inflamed granulation tissue
Acute and chronic inflammation
Positive stains
- Fibrinogen
Electron microscopy images
Images hosted on other servers:
Fibrillar deposits
Differential diagnosis
- Adenovirus infection
- Chlamydia
- Graft versus host disease: see Hum Pathol 1996;27:307
- Klebsiella
- Streptococcus
- Toxic epidermal necrolysis
Additional references
