The cause of ligneous conjunctivitis has been linked to severe type I plasminogen deficiency, with hypofibrinolysis as the primary defect. More than 12% of patients have severe hypoplasminogenemia. The genetic defect in the plasminogen gene (PLG) is located at band 6q26.
Ligneous conjunctivitis can affect patients of all ages. Patients present with symptoms of ocular irritation and foreign-body sensation. The cardinal finding consists of yellowish, platelike masses that overlie one or more of the palpebral surfaces and are readily visible with eversion of the eyelid (see Fig 11-8). Ligneous conjunctivitis is generally bilateral and frequently recurs after excision.
Figure 11-8 Firm yellowish lesions of the eyelids characteristic of ligneous conjunctivitis.
(Courtesy of John Dart, MD.)
Cultures can be taken at initial diagnosis to exclude a bacterial pseudomembranous or membranous conjunctivitis. Surgical excision with or without adjunctive cryotherapy has been advocated. However, recurrences are frequent. Use of purified plasminogen, fresh frozen plasma, heparin, corticosteroids, azathioprine, and amniotic membrane has been reported. No single treatment has been shown to be consistently effective or superior. Many cases of ligneous conjunctivitis eventually resolve spontaneously after several months to a few years.
Heidemann DG, Williams GA, Hartzer M, Ohanian A, Citron ME. Treatment of ligneous conjunctivitis with topical plasmin and topical plasminogen. Cornea. 2003;22(8):760–762.
Hiremath M, Elder J, Newall F, Mitchell S, Dyas R, Monagle P. Heparin in the long-term management of ligneous conjunctivitis: a case report and review of literature. Blood Coagul Fibrinolysis. 2011;22(7):606–609.
Rodríguez-Ares MT, Abdulkader I, Blanco A, et al. Ligneous conjunctivitis: a clinicopathological, immunohistochemical, and genetic study including the treatment of two sisters with multiorgan involvement. Virchows Arch. 2007;451(4):815–821.
Schuster V, Seregard S. Ligneous conjunctivitis. Surv Ophthalmol. 2003;48(4):369–388.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.