Ligneous conjunctivitis. Response to topical cyclosporine and mitomycin

AbstractPurpose We report a case of a 50‐years‐old female referred for pseudomembranous conjunctivitis in the left eye(LE) that is unresponsive to conventional antibiotic treatment, presenting continual recurrence of the membranes after extraction.Methods Left eye showed hyperemia with yellowish‐white pseudomembranes adherent to the tarsal conjunctiva.The extraction of the membranes lead to relapse within a few days.She was treated with antibiotics and topical anti‐inflammatory without improvement.Results The culture was negative.We associated systemic steroids and excision of the membranes with topical mitomycin.Pathological anatomy confirmed the diagnosis of ligneous conjunctivitis,so topical cyclosporine A is added,but persisted upper tarsal pseudomembrane.At this time,repeated injections of mitomycin were performed at the upper eyelid,with remarkable clinical improvement.After months of gradual withdrawal of treatment,the disease remited leaving a retraction in the upper eyelid.Conclusion Ligneous conjunctivitis is a rare form of chronic conjunctivitis characterized by recurrent formation of conjunctival pseudomembranes‐rich fibrin.It begins in childhood as a bilateral conjunctivitis that does not respond to conventional treatments,with yellowish‐white pseudomembranes that progress to form woody masses that replace the normal mucosa.Its pathogenesis is unknown,but recently has been associated with type I plasminogen deficiency.These patients may have lesions on other mucous membranes.Treatment consists of topical antibiotics and anti‐inflammatories as well as heparin, cyclosporine and topical mitomycin, or the recent addition of topic plasminogen.The visual prognosis is closely related to corneal involvement present in 30% of cases.