Membranous Conjunctivitis Research Articles

One-time low concentration betadine eye wash: A novel treatment for epidemic viral conjunctivitis for accelerated recovery.

This study aims to renew the management of viral epidemic conjunctivitis by introducing a one-time, low-concentration ocular surface povidone-iodine (LOS-pI) wash. Among the 3,002 patients screened, 1,328 with acute conjunctivitis were categorized into two groups. Group A (664 patients) underwent a 1% betadine wash in addition to the standard treatment protocol (Eye Lubricant + Moxifloxacin 0.5% eyedrops), while Group B (664 patients) followed the standard protocol alone. In cases of membranous conjunctivitis, manual membrane removal was performed. Treatment responses were observed daily for three days, followed by weekly assessments for two additional weeks. Co-infection of adenovirus with enterovirus was found to be the main cause, often accompanied by staphylococcal superinfection. Group A showed complete resolution of conjunctival inflammation, with a remarkable 76.05% of patients experiencing improvement within an average of 2.6±0.51 days, in contrast to Group B's average of 7.5±1.1 days (p <0.05). Additionally, 13% of Group B patients with recalcitrant conjunctivitis significantly recovered following the 1% betadine wash. Complications (subconjunctival hemorrhage: 34.04%, superficial punctate keratitis: 6.02%) were more prevalent in Group B. The authors hypothesized that a single wash with betadine is sufficient to reduce disease duration and prevent secondary infections and complications. The core strength of our study lies in its substantial sample size. To our knowledge, no similar previous research has been conducted, on such a larger scale. Viral conjunctivitis brings discomfort, work absenteeism, and financial burden. A single low-concentration betadine wash expedites recovery and reduces complications in acute infective conjunctivitis. This approach significantly enhances patient outcomes and alleviates the socioeconomic impact of the condition.

Anterior Segment Surgeries Under Topical Fresh Frozen Plasma Treatment in Ligneous Conjunctivitis.

To evaluate the efficacy of topical fresh frozen plasma (FFP) therapy on clinical symptoms, findings, and prognosis after anterior segment surgeries in patients with ligneous conjunctivitis (LC). Retrospective case note review. Eleven eyes of 7 cases whose remission was not achieved after medical treatment such as topical corticosteroids, cyclosporine A, and heparin were included in the study. The median age of admission was 19 (1-49) years, median duration of FFP treatment was 48 (15-79) months, median follow-up period was 62 (16-114) months, and median age at symptom onset was 12 (4-252) months. Diagnosis was made according to clinical presentations, plasminogen activities, and response to treatment. Topical FFP that was prepared in our clinic was used in all cases. Surgeries (membrane excision, eyelid surgery, deep anterior lamellar keratoplasty, and cataract surgery) were performed after at least 1 month of FFP treatment. Prosthetic contact lens was applied to one eye. During the follow-up period, recurrences requiring membrane excision and side effects from topical FFP were not observed. LC is a rare membranous conjunctivitis that proceeds with remissions and recurrences. When it was shown that the etiology of LC is plasminogen deficiency, FFP became the only treatment option targeting the etiology. In this study, we observed that the topical FFP is an effective treatment method that prevents recurrence and ensures regression of membranes and safer anterior segment surgeries in LC.

Plasminogen Eye Drops Are Effective in Preventing Recurrence of Pseudomembranes in Ligneous Conjunctivitis: Results from the Phase 2/3 KB046 Trial

BACKGROUND Ligneous Conjunctivitis (LC) is the most common clinical manifestation of type-1 plasminogen (PLG) deficiency, a very rare autosomal recessive disorder with an estimated prevalence of ~1.6/million. LC is a membranous conjunctivitis characterized by the formation of fibrin-rich, soft/hard pseudomembranes on tarsal conjunctivae, resulting in visual impairment/loss, and commonly presents in the first weeks/months of life, but may present in childhood or any age. PLG is the precursor of plasmin; absence of plasmin activity results in impaired fibrinolysis and formation of fibrin-rich membranes. LC affects bilateral eyes in up to 51% of cases, and corneal involvement, leading to blindness, occurs in 20-30% of cases. Although non-specific therapies have been reported to result in lesion improvement/resolution, only FFP administered topically or systemically, and topical/systemic plasminogen have demonstrated more consistent efficacy. Surgery is often performed for hard membrane removal; surgical intervention can trigger regrowth without adequate medical therapy. We report the long-term results of topical ocular administration from a PLG eye drop formulation [Kedrion Biopharma, CVP, Barga, Italy] for LC. METHODS A phase 2/3, 3-segment [Fig], open label, historically controlled, clinical trial (KB046) was initiated in May 2013 at three sites (1 US; 2 Italy). Segments 1 &amp; 2 assessed the efficacy and safety of short-term PLG treatment in pseudomembrane regression/recurrence and prevention. Subjects with residual hard membranes at Segment 1 end underwent surgical removal. Patients completing Segment 2 without pseudomembranes continued to segment 3 for long-term safety continuation. Segment 3 is ongoing. Primary and secondary Efficacy Endpoints: a) Pseudomembrane recurrence prevention at end of Segment 2 and b) Regression of surface area of existing pseudomembranes at end of Segment 1 including Time (days) to pseudomembrane recurrence post-surgery or complete regression at end Segment 2. Regression and recurrence occurring during the trial were compared to the patients' prior treatments and surgical history. Safety Endpoints of segment 1/2 included overall safety, local tolerability, immunogenicity and viral safety. RESULTS Eleven patients (15 eyes) with pseudomembranes were enrolled in segment 1 and treated for 4 weeks with PLG drops. At Segment 1 end, four patients showed regression, proceeded to Segment 2, and treated with PLG drops for 8 weeks to prevent recurrence; seven patients had residual hard pseudomembranes and underwent surgical removal followed by 8 weeks with PLG. At Segment 2 end, 10 patients compliant per protocol without recurrence, transitioned to Segment 3. The primary endpoint of no pseudomembrane recurrence was 100% in all patients compliant with the treatment regimen at end Segment 2. Regression of surface area of existing pseudomembranes at end Segment 1 was achieved in 83.3% of affected eyes. Prior to trial enrollment, all patients experienced recurrences with prior historical therapies. Eleven patients were treated in segment 3 with 3 ongoing (as of July, 2020). Eight patients exited the study: one patient due to noncompliance, and two who developed systemic manifestations requiring other therapy. No other subjects have experienced new eye lesions. No major safety concerns arose during any the 3 Segments. Final data on immunogenicity will be available at the end of 2020. CONCLUSIONS Kedrion PLG eye drops were well tolerated and effective in recurrence prevention of pseudomembranes in patients with LC due to PLG deficiency who were compliant with the study protocol with long term follow-up now at 7 years (median: 74 months, range: 37-85 months); 3 subjects are still ongoing. Disclosures Caputo: Kedrion SpA: Research Funding. Suffredini:Kedrion SpA: Current Employment. Calcinai:Kedrion SpA: Current Employment. Crea:Kedrion SpA: Current Employment. Mathew:Kedrion SpA: Consultancy, Membership on an entity's Board of Directors or advisory committees. Nakar:Kedrion SpA: Research Funding; Prometic Biotherapeutics: Research Funding. Shapiro:Genentech/Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Kedrion Biopharma: Research Funding; Daiichi Sankyo: Research Funding; BioMarin: Research Funding; Novartis: Research Funding; Novo Nordisk: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Agios: Research Funding; ProMetic Bio Therapeutics: Consultancy, Research Funding; OPKO: Research Funding; Glover Blood Therapeutics: Research Funding; Sigilon: Consultancy, Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novo Nordisk Hemophilia Foundation: Membership on an entity's Board of Directors or advisory committees; Catalyst BioSciences: Membership on an entity's Board of Directors or advisory committees; Bioverativ: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Research Funding; Octapharma: Research Funding; Sangamo: Research Funding. OffLabel Disclosure: Plasminogen eye drops, for treatment of Ligneous conjunctivitis due to Plasminogen Type I deficiency

Fresh frozen plasma (Octaplas) and topical heparin in the management of ligneous conjunctivitis

Ligneous conjunctivitis is a rare form of chronic recurrent membranous conjunctivitis with reduced plasminogen activity. It is characterized by the formation of characteristic firm ("woody") membranes on the tarsal conjunctiva. Similar lesions may occur on other mucous membranes. When treated with local excision, ligneous conjunctivitis is invariably associated with recurrences. Various therapeutic modalities, including topical heparin, cyclosporine, fresh frozen plasma (FFP), plasminogen, and amniotic membrane transplantation have been reported to reduce postoperative recurrences. We present 2 cases of recurrent ligneous conjunctivitis in children successfully managed with surgical excision under cover of FFP transfusion, amniotic membrane grafting, and combined with concomitant postoperative administration of topical heparin, steroids.

Response of Plasminogen Deficiency Associated Ligneous Conjunctivitis to Topical Fresh frozen Plasma with Heparin

Introduction: Ligneous conjunctivitis is rare form of conjunctivitis characterized by woody fibrinous membranes. Plasminogen deficiency has been introduced as the most common cause and formation of membrane is the result of impaired wound healing process. Case Report: We present a 4-month-old male infant with chronic membranous conjunctivitis. Multiple scrapping of membranes were performed with no improvement. Fibrinous membranes were also seen on nasal cavity and upper gingiva. After his blood revealed plasminogen blood levels of 11.9% (normal: 75-135%), diagnosis of ligneous conjunctivitis due to plasminogen deficiency was obtained. Treatment was then changed to topical fresh frozen plasma and heparin. Dramatic resolution of membranes was observed after 15 months therapy combined with membranes scraping. Conclusion: Ligneous conjunctivitis is rare manifestation of plasminogen deficiency that occurs sporadically where local infection and multiple surgeries might act as trigger to induce fibrinous membranes. Topical heparin and FFP could treat the disease successfully.

Treatment of ligneous conjunctivits with subconjunctival fresh frozen plasma (ffp): about three severe cases

AbstractPurpose Ligneous conjunctivitis is a rare type of chronic membranous conjunctivitis. It is inherited as an autosomal recessive disorder, with low plasminogen levels reported in both homozygous and heterozygous individualsMethods we describe the clinical features and response to subconjunctival FRESH FROZEN PLASMA (FFP) in three patients with severe ligneous conjunctivitis with a mean follow‐up of 12 months, among 15 patients followed in our department for the past 10 years.Results All our cases had bilateral ocular involvement except. They were all treated with subconjunctival injection of FFP after resection of the membranes. Topical heparin and rimexolone application was continued 1 month after surgery. As the case 2 presented a corneal perforation during the course of the disease, he was also treated with multiple inlay amniotic membrane graft.Conclusion FFP shortens the treatment period, reduces the probability of mid‐term recurrences and is a good alternative to a long‐term topical treatment with Heparin and steroid.

Treatment of ligneous conjunctivitis with amniotic membrane transplantation and topical cyclosporine

Ligneous conjunctivitis (LC) is a rare form of bilateral chronic recurrent disease in which thick membranes form on the palpebral conjunctiva and other mucosal sites. We report the clinical features and describe the management of two cases. Case 1 was an 8-month-old patient with bilateral membranous conjunctivitis. Case 2 was a 5-year-old patient with unilateral membranous conjunctivitis, esotropia, mechanical ptosis and complicated cataract, and had been treated with a number of medications. Histological investigation of the membrane in both cases showed LC. Treatments with amniotic membrane transplantation and institution of topical cyclosporine have shown good response. There has been complete resolution of the membranes with no recurrence at the end of 40- and 28-month follow-ups, respectively. No treatment related side effects were seen. Thus, it appears that amniotic membrane transplantation and topical cyclosporine are effective alternatives for the treatment of LC.

Membranous conjunctivitis from adverse drug reaction: Stevens–Johnson syndrome

Membranous conjunctivitis from adverse drug reaction: Stevens–Johnson syndrome

Systemic and Topical Fresh-Frozen Plasma Treatment in a Newborn With Ligneous Conjunctivitis

We report the results of systemic and topical fresh-frozen plasma (FFP) treatment and conjunctival membrane excision of a newborn with ligneous conjunctivitis. The newborn, referred because of bilateral membranous conjunctivitis, was hospitalized with the preliminary diagnosis of gonococcic conjunctivitis. The conjunctival membranes were excised on the fourth day of topical antibiotherapy. Plasminogen deficiency and ligneous conjunctivitis were diagnosed from the hematology consultation after recurrence of the conjunctival membranes. FFP was used systemically and topically. After this medical treatment period, the conjunctival membranes were excised with electrocautery under general anesthesia. Topical FFP was gradually decreased after surgery and ended in the third postoperative month. Recurrence was not seen through the first postoperative year. Topical and systemic FFP treatment and conjunctival membrane excision may help rapid rehabilitation and prevent recurrence in cases with ligneous conjunctivitis.

Ligneous conjunctivitis secondary to a congenital plasminogen deficiency in a dog

A 7-month-old 16.6-kg (36.5-lb) sexually intact female Golden Retriever was evaluated because of progressive severe bilateral membranous conjunctivitis, oral lesions, nasal discharge, and cough. Histologic examination of conjunctival biopsy specimens revealed findings consistent with ligneous conjunctivitis. Circulating plasminogen activity was repeatedly low, and congenital plasminogen deficiency was identified as the underlying cause of the ocular, oral, and respiratory lesions. Topical and subconjunctival administrations of fresh frozen plasma (FFP), topical administration of cyclosporine, and oral administration of azathioprine had no effect on the conjunctival membranes. Excision of the membranes followed by intensive treatment with topical applications of heparin, tissue plasminogen activator, corticosteroid, and FFP and IV administration of FFP prevented membrane regrowth. Intravenous administration of FFP increased plasma plasminogen activity to within reference limits, improved respiratory and oral lesions, and resulted in weight gain; discontinuation of this treatment resulted in weight loss, signs of depression, and worsening of lesions. After euthanasia because of disease progression, necropsy findings included mild hydrocephalus; multifocal intestinal hemorrhages; and fibrinous plaques in the oral cavity, nasopharynx, trachea, esophagus, and pericardium. Microscopically, the plaques were composed of fibrin and poorly organized granulation tissue. Fibrin thrombi were present within vessels in the lungs, oral cavity, and trachea. In dogs, congenital plasminogen deficiency can occur and may be the underlying cause of ligneous conjunctivitis. A combination of surgical and medical treatments may improve conjunctival membranes, and administration of FFP IV appears to be effective in treating nonocular signs of plasminogen deficiency.

PL3 Stevens Johnson syndrome and mucous membrane pemphigoid: ocular manifestations and their management

Stevens Johnson Syndrome (SJS), its severe form Toxic Epidermal Necrolysis (TEN), and mucous membrane pemphigoid (MMP) are the major autoimmune causes of conjunctival scarring. Between them these diseases present some of the most difficult management problems in ophthalmology. SJS/TEN develop conjunctival disease as part of the acute generalised mucosal involvement. The conjunctivitis varies from a papillary reaction with watery discharge to a membranous conjunctivitis with sloughing of the conjunctival epithelium. Corneal epithelial defects are common and may progress to corneal ulceration with or without bacterial superinfection. Although the morbidity may be due to the acute corneal complications it more usually results from the progressive effects of the conjunctival scarring, the secondary ocular surface disease, infections &amp; treatment toxicity that occur later. Some cases of SJS/TEN develop the following late inflammatory diseases: recurrent conjunctival inflammation without scarring (recurrent SJS), inflammation with cicatrisation like ocular MMP (SJS‐MMP) and scleritis. On the other hand ocular MMP (MMPO) presents with acute conjunctivitis and limbitis in only 10% of cases; the remainder present with subacute or low grade chronic inflammation and progressive scarring. Progression in MMPO is due to the same factors that cause the morbidity in SJS/TEN (conjunctival scarring, the secondary ocular surface disease, infections &amp; treatment toxicity) coupled with the effects of the progressive conjunctival inflammation and scarring that is a feature of all cases of MMPO, but occurs in a few cases of SJS/TEN with ocular involvement. Successful management of both SJS/TEN and CP demands identification of the components of the disorder due to (i) surface disease, (ii) treatment toxicity (iii) immune mediated inflammation and (iv) infection. These problems lead to a dry eye, surface failure and corneal blindness. All these components of the problem require prompt treatment to prevent progression to surface failure because of the poor prognosis for rehabilitation, by corneal graft surgery and/or surface reconstruction, in this group of patients.

Prevention of ligneous conjunctivitis by topical and subconjunctival fresh frozen plasma

Purpose To present a case of ligneous conjunctivitis where the recurrence of membranous conjunctivitis was prevented by subconjunctival and topical instillation of fresh frozen plasma. Design Interventional case report. Methods A case of ligneous conjunctivitis with multiple recurrences since the age of 3 years developed recurrent membranous conjunctivitis after transconjunctival levator recession. Blood plasminogen activity was determined. The membrane was excised, and the membrane reappeared 4 days later. The patient was treated with excision of the membrane and subconjunctival injection of fresh frozen plasma and topical fresh frozen plasma. Plasminogen activity of the fresh frozen plasma was normal. Results Plasminogen blood functional activity was 52% (normal is 80%–120%). The patient had complete remission with no recurrences of membranous conjunctivitis after topical and subconjunctival fresh frozen plasma. Conclusions Prophylactic use of topical and subconjunctival fresh frozen plasma may help in the prevention of membranes in susceptible patients with plasminogen deficiency.

Treatment of Ligneous Conjunctivitis with Topical Plasmin and Topical Plasminogen

To describe treatment of a child with recalcitrant ligneous conjunctivitis secondary to a systemic plasminogen deficiency. Interventional case report. A seven-year-old boy developed severe unilateral membranous conjunctivitis recalcitrant to surgical debridement and treatment with topical prednisone, topical cyclosporine, and oral prednisone. Systemic evaluation revealed a severe plasminogen deficiency. Treatment with surgical debridement and topical plasmin was ineffective and resulted in prompt recurrence of dense conjunctival membranes. Treatment with topical plasminogen resulted in dramatic improvement and complete resolution of the membranes. Ligneous conjunctivitis is secondary to a systemic plasminogen deficiency. Treatment with topical plasminogen resulted in prompt resolution of the membranes. Treatment with topical plasmin was ineffective.

Effective treatment of ligneous conjunctivitis with topical plasminogen

PURPOSE: The etiology of ligneous conjunctivitis is now known to be due to an underlying type 1 plasminogen deficiency. We hereby report the clinical features of three cases and their response to topically administered plasminogen. DESIGN: Observational case series. METHODS: Two Caucasian females aged 5 years and an 18-month male of north African descent presented with a membranous conjunctivitis, which recurred after surgical excision. Case 1 presented before the association with plasminogen deficiency was known with a bilateral chronic membranous mucopurulent conjunctivitis from the age of 14 months associated with bronchiolitis and gingival hyperplasia. A diagnosis of ligneous conjunctivitis was entertained and a number of drops were instituted. At the age of 4 years plasminogen levels were ordered. Case 2 presented at the age of 4 years with a unilateral chronic membranous conjunctivitis. Plasminogen levels were requested as soon as a diagnosis of ligneous conjunctivitis was suspected. Case 3 was born with congenital hydrocephalus. Conjunctivitis was treated with antibiotics from the age of 1 month. He presented to the eye clinic at the age of 5 months when a clinical diagnosis of ligneous conjunctivitis was entertained and treated with a number of medications. Plasminogen levels were available at 9 months of age. RESULTS: The two female patients returned plasminogen levels of 0.25 U/ml and 0.3 U/ml, well below the normal level of 0.7–1.0 U/ml. Functional plasminogen levels in the male infant were not recordable with plasminogen antigen levels of 0.125 U/ml (normal range, 0.52–1.82). All cases have responded well to excision of the membranes and institution of topical plasminogen drops. There has been no recurrence with more than 12 months’ follow-up. CONCLUSIONS: With the knowledge of the etiology of ligneous conjunctivitis, efforts are underway to identify the best method of delivery of plasminogen. Topical plasminogen concentrate from fresh frozen plasma holds promise as the definitive treatment for this chronic membranous conjunctivitis

LIGNEOUS CONJUNCTIVITIS IN A HORSE: A CASE OF ELEVEN MONTHS DURATION

A six months old throughbred female race horse was received presenting events of mucous purulent discharge from the right eye for two days. Close examination of both eyes revealed bilateral mucous purulent conjunctivitis, more severe on the left eye where discharge was more profuse, with tarsal and bulbar chemosis and blepharospasm. This animal also had a fluoresceine fixing superficial linear ulcer on the left eye. It was performed culture of material from the botton of conjunctive sack, which revealed an infection by Pseudomonas spp, sensitive to tobramycine. Based upon microbiological tests, tobramycine eye drops (15 mg/ml) and ophtalmic ointment (15 mg/g) was given for three weeks, and a two percent atropine and one percent dichorphenac eye drops were given for five days. At the end of the treatment, the right eye was calm and without alterations while the left eye displayed a tarsal membranous conjunctivitis with minimal serous ocular discharge. The presence of an allergic conjunctivitis was suspected and four percent dissodium chromoglicate eye drops were given. In spite of the decrease of inflamation observed, the conjunctive membranes remained. Surgical debridement of the membranes was performed and representative material was collected and sent for histological examination. Based upon human and canine reports and histological findings, the most probable diagnosis was ligneous conjunctivitis. After biopsy, the drug chromoglicate was replaced by one percent prednisolone eye drops for three weeks. After this, the eye showed a discreet dorsal tarsal chemosis and hyperemia but no membranous conjunctivitis. As supporting therapy a daily morning instillation of corticoid for 30 days was ordered. Five months later, a recurrence of the membranous conjunctivitis was verified and these membranes invaded the cornea, causing temporal pigmentary keratitis. A two percent cyclosporine ointment was then given and a new biopsy asked. The diagnosis of recurrent severe ligneous conjunctivitis was evident, and a wide surgical resection of the membranes and vascular cauterization was decided. Postoperative treatment was composed by one percent prednisolone, one and a half percent tobramicine eye drops together with 5,000 IU /ml heparin. Treatment proceeded for 30 days when the antibiotic was taken off, corticoid frequency was reduced and topic heparin kept. Ligneous conjunctivitis is a chronic membranous conjunctivitis with presence of membranes mainly in the tarsal superior conjunctives, of ignored etiology. Up to the present, two months after the surgical resection of the membranes, the topical use of corticoid and heparin satisfactorily controls the case, now eleven months old.

THERAPY FOR BACTERIAL CONJUNCTIVITIS

Bacterial conjunctivitis is most often a self-limited disease. Most cases are successfully treated with a topical antibiotic agent. Treatment is indicated to shorten the disease course and reduce contagious spread. Therapy is usually empiric, requiring an understanding of the likely pathogens in a given patient population. There are unusual situations, however, in which conjunctival cultures should be performed and those in which systemic therapy is required. Conjunctivitis occurs when pathogenic bacteria overwhelm conjunctival defenses, resulting in inflammation. Organisms causing conjunctivitis may be components of the normal lid flora (e.g., Staphylococcus aureus ) or nasopharyngeal flora (e.g., Hemophilus influenzae ), or may be introduced by hand or aerosolized contact. The degree of inflammation, discharge, and symptoms vary. Most cases, up to 80%, become bilateral, justifying bilateral treatment even when presenting unilaterally. 42 A typical case of conjunctivitis may be symptomatic for 8 days if left untreated, as opposed to only 4 days with treatment. 12 Thus, treatment with topical agents is indicated usually within only 4 days of symptom onset. 21 Acute conjunctivitis is defined by onset within 3 weeks of presentation. Hyperpurulent conjunctivitis manifests with profuse purulence, lid edema, chemosis, and subconjunctival hemorrhages. Neisseria gonorrhoeae and Neisseria meningitidis classically cause hyperpurulent conjunctivitis, though Streptococcus and Staphylococcus species may be causative. 22 Streptococcus pyogenes and Corynebacterium diphtheriae can cause an acute membranous conjunctivitis. 38 Chronic conjunctivitis is defined by persistence for at least 3 weeks. Chronic conjunctivitis is frequently caused by Staphylococcus aureus or Moraxella lacunata, and is often related to continued bacterial exposure from blepharitis or dacryocystitis. 38

Topical Heparin in the Treatment of Ligneous Conjunctivitis

Ligneous conjunctivitis is a rare acute or subacute membranous conjunctivitis of unknown etiology for which no generally accepted form of treatment is available. Between 1972 and 1993, 17 patients with ligneous conjunctivitis were treated with excision biopsy, meticulous hemostasis, and immediate, intensive topical treatment with heparin, steroids, and, in 12 patients, alpha-chymotrypsin until all signs of conjunctival inflammation had subsided. On histologic examination, the lesions consisted of subepithelial deposits of fibrin in all patients. Eight patients had no recurrence (mean follow-up, 33.1 months) and in four patients the conjunctivitis was controlled after one repeat excision and topical treatment (mean follow-up, 40.3 months). One patient had three recurrences before responding to treatment (follow-up, 24 months). In four patients, treatment was unsuccessful, although lesion-free intervals were longer than usually seen in this condition (mean, 7.8 months). These results suggest that intensive and early use of topical heparin may improve therapy results in ligneous conjunctivitis.

Cicatricial Pemphigoid and Erythema Multiforme

Cicatricial pemphigoid (CP) and erythema multiforme (EM) are bullous diseases that involve the skin and mucous membranes including the conjunctiva. Of all the bullous diseases, CP and EM not only involve the conjunctiva most frequently but also cause the most severe conjunctival disease. A chronic, progressive disease, CP is characterized by shrinkage of the conjunctiva, symblepharon, entropion, trichiasis, dry eye, and finally reduced vision from corneal opacification. It is primarily a disease of the elderly that affects more women than men and is characterized by blisters or bullae in a subepithelial location and immunoglobulins and complement bound to the basement membrane zone of skin and mucous membranes including the conjunctiva. Circulating antibodies to the basement membrane zone can be demonstrated occasionally. Treatment includes artificial tears, topical antibiotics, correction of entropion and trichiasis, therapeutic soft contact lenses, and systemic immunosuppressive therapy including corticosteroids. An acute, generally self-limited, inflammatory disorder of the skin and mucous membranes, EM occurs primarily in young, healthy individuals. The most frequent precipitating factors are (1) drugs and (2) infections caused by Mycoplasma pneumoniae and herpes simplex. Conjunctival involvement ranges from a mild catarrhal conjunctivitis which terminates without sequelae to membranous conjunctivitis which may heal leaving scarring, symblepharon, and even ankyloblepharon. Histopathologic findings include subepithelial bullae and perivascular mononuclear cell infiltrates. Patients with EM have circulating immune complexes and immunoreactant deposition in the blood vessel walls of the dermis. After the acute episode has subsided, they may require artificial tears, topical antibiotics, correction of entropion and trichiasis, therapeutic soft contact lenses, tarsorrhaphy, and mucous membrane grafts.

Cicatricial pemphigoid and erythema multiforme.

Cicatricial pemphigoid (CP) and erythema multiforme (EM) are bullous diseases that involve the skin and mucous membranes including the conjunctiva. Of all the bullous diseases, CP and EM not only involve the conjunctiva most frequently but also cause the most severe conjunctival disease. A chronic, progressive disease, CP is characterized by shrinkage of the conjunctiva, symblepharon, entropion, trichiasis, dry eye, and finally reduced vision from corneal opacification. It is primarily a disease of the elderly that affects more women than men and is characterized by blisters or bullae in a subepithelial location and immunoglobulins and complement bound to the basement membrane zone of skin and mucous membranes including the conjunctiva. Circulating antibodies to the basement membrane zone can be demonstrated occasionally. Treatment includes artificial tears, topical antibiotics, correction of entropion and trichiasis, therapeutic soft contact lenses, and systemic immunosuppressive therapy including corticosteroids. An acute, generally self-limited, inflammatory disorder of the skin and mucous membranes, EM occurs primarily in young, healthy individuals. The most frequent precipitating factors are (1) drugs and (2) infections caused by Mycoplasma pneumoniae and herpes simplex. Conjunctival involvement ranges from a mild catarrhal conjunctivitis which terminates without sequelae to membranous conjunctivitis which may heal leaving scarring, symblepharon, and even ankyloblepharon. Histopathologic findings include subepithelial bullae and perivascular mononuclear cell infiltrates. Patients with EM have circulating immune complexes and immunoreactant deposition in the blood vessel walls of the dermis. After the acute episode has subsided, they may require artificial tears, topical antibiotics, correction of entropion and trichiasis, therapeutic soft contact lenses, tarsorrhaphy, and mucous membrane grafts.

Scleral Grafting in the Management of Ligneous Conjunctivitis

Ligneous conjunctivitis is a rare, usually bilateral, chronic membranous conjunctivitis, which begins acutely in childhood and persists for many years. In view of the poor results obtained with other forms of therapy in the past, the resection of the involved conjunctiva and tarsus with the grafting of donor sclera is offered as another alternative in the management of this distressing condition.