Ligneous conjunctivitis

Last author update: 1 October 2014
Last staff update: 19 May 2022

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PubMed Search: Ligneous conjunctivitis [title]

Deepali Jain, M.D.
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Cite this page: Jain D. Ligneous conjunctivitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/eyeconjligneous.html. Accessed June 16th, 2024.
Definition / general
  • Chronic relapsing pseudomembranous conjunctivitis with woody induration of eyelid and tarsal conjunctiva and pseudomembrane on tarsal conjunctiva
  • Also affects other mucosa
  • Usually children (median age 5 years), but can occur in adults
  • Unilateral or bilateral
  • Palpebral most common but also limbal and bulbar conjunctiva
  • 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
  • Decreased serum level of plasminogen type I
Case reports
Clinical images

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Plaque like ulceration

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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

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Eosinophilic deposits surround islands of epithelial cells

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Eosinophilic hyalinized tissue with inflammation

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Histopathology of conjunctival biopsies

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Inflamed granulation tissue

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Acute and chronic inflammation

Positive stains
  • Fibrinogen
Negative stains
Electron microscopy images

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Fibrillar deposits

Differential diagnosis
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