Ligneous conjunctivitis after pingueculae removal in an adult

A 45-year-old man who had uneventful excision of bilateral pingueculae developed bilateral membranous lesions involving the bulbar conjunctivae and corneas. Histologically, the membranes were composed mainly of large fibrinous deposits intermixed with acute and chronic inflammatory cells with areas of fibroblastic and capillary proliferation resembling granulation tissue. By electronmicroscopy the amorphous acidophilic masses were composed of electron-dense, fibrillar material with a periodicity of 10-12 mm, which was consistent with fibrin. Despite mechanical removal of the membranes, they continued to recur rapidly over a period of several months. The lesions apparently responded slowly to topical enzymatic therapy that consisted of hyaluronidase (175 U/ml) and alpha-chymotrypsin (1:5000) drops. Follow-up examination, approximately 1 year after surgery, revealed that the patient was asymptomatic. Ocular examination disclosed slight persistence of gelatinous membranes on the bulbar conjunctivae, most prominent in the left eye.