Treatment of ligneous conjunctivitis with topical plasmin and topical plasminogen

Area of Science:

• Ophthalmology
• Hematology

Background:

• Ligneous conjunctivitis is a rare, severe form of conjunctival inflammation characterized by thick, woody exudates.
• It is often associated with underlying systemic conditions, necessitating comprehensive evaluation.

Observation:

• A pediatric patient presented with severe, unilateral membranous conjunctivitis unresponsive to conventional therapies including surgical debridement, topical steroids, and immunosuppressants.
• Systemic workup revealed a severe deficiency in plasminogen, a key protein in the fibrinolytic system.

Findings:

• Initial treatment with topical plasmin, an enzyme involved in clot breakdown, was ineffective, leading to rapid recurrence of conjunctival membranes.
• Subsequent administration of topical plasminogen resulted in significant clinical improvement and complete resolution of the dense membranes.

Implications:

• This case highlights topical plasminogen as a targeted and effective therapy for ligneous conjunctivitis secondary to plasminogen deficiency.
• Early diagnosis of plasminogen deficiency is crucial for initiating appropriate treatment and preventing complications associated with ligneous conjunctivitis.