A rare condition known as “ligneous conjunctivitis” is characterized by the accumulation of a protein called fibrin, which leads to conjunctival inflammation (conjunctivitis) and the development of thick, woody (ligneous) inflammatory lesions that are yellow, white, or red. The inside of the eyelids is the most typical location for ligneous conjunctivitis, although it can also harm the sclera, cornea, and pupil, limiting vision. The larynx, vocal cords, nose, trachea, bronchi, vagina, cervix, and gingiva may all experience symptoms of the condition’s systemic version.

Introduction:

A rare kind of chronic conjunctivitis called ligneous conjunctivitis is characterized by persistent, fibrin-rich pseudomembranous lesions with a substance similar to wood that mostly appear on the inside of the eyelids (tarsal conjunctiva). It is typically a systemic illness that can affect the female genitalia, both the lower and upper respiratory tracts, the kidneys, and periodontal tissue. It can be fatal, and pulmonary involvement occasionally results in death. Hola ligneous conjunctivitis has been hypothesized to represent an IgG4-related illness (IgG4-RD) affecting the conjunctiva.

The interior of the eyelids is among the most typical locations for ligneous conjunctivitis, but it can also harm the sclera, cornea, and pupil, limiting visibility. The primary clinical symptom of systemic plasminogen insufficiency, which frequently first appears in childhood. Females have ligneous conjunctivitis more commonly than males do. The ability to heal wounds is impaired by plasminogen insufficiency, and this effect is most notable in mucous membranes like the conjunctiva.

Causes:

There is no recognized cause of ligneous conjunctivitis. In some circumstances, inheritance with autosomal recessive characteristics has been proposed. Congenital plasminogen deficiency is a disease that is occasionally linked to ligneous conjunctivitis. Humans with the condition have histopathological results that show a lack of plasmin-mediated extracellular fibrinolysis impairs wound healing. Minor injuries, ocular surgery, or systemic events like infections or antifibrinolytic medication can also cause episodes. Histology reveals fibrin-dominant unstructured subepithelial deposition of eosinophilic material.

The ability to heal wounds is impaired by plasminogen insufficiency, and this effect is most notable in mucous membranes like the conjunctiva. Granulation tissue production is stopped due to the decreased wound healing capacity, and there is an excessive buildup of fibrin. As a result, mucous membranes rich in fibrin build up, encouraging fibroblasts and inflammatory cells, while desiccation of the fibrin causes the ligneous consistency of the conjunctive lesions. Extra-ocular plasminogen shortage phenotypes share similar patho-physiologic processes. In extra-vascular areas, fibrinolysis is compromised and plasminogen activity is minimal to nonexistent. The absence of thrombotic symptoms in patients with LC and plasminogen insufficiency suggests that this is not the case in vessels, though.

Symptoms:

Mucoid release, tearing, and conjunctival redness are the most typical early symptoms of ligneous conjunctivitis. Palpebral conjunctival pseudomembrane production comes next, and eventually, the normal eyelid mucosa is replaced by a mucosal thickening with a wood-like substance. Multiple instances of recurrence or persistent pseudomembranous conjunctivitis may appear in the patient, which may be accompanied by or coincide with systemic symptoms such as fever, ear infections, upper respiratory tract infections, or, in females, urogenital tract infections.

Mild cases

• Redness.
• Persistent watering.
• Mild discomfort.
• Pain.
• Sensitivity to light (photophobia)
• Conjunctival masses can be white or crimson.

Extreme cases

• Ongoing discomfort that interferes with regular tasks.
• Beyond the lid edge, lesions may spread.
• Membranes.

Diagnosis:

Given the pseudomembranous appearance that can be linked to other disorders (see differential diagnosis below), determining the cause of ligneous conjunctivitis might be difficult. However, if there is a recurrence, particularly after ripping off the membranes, or if widespread mucosal involvement is noticed, particularly in a youngster, concern must be raised. Inspecting the ears, oropharynx, tracheobronchial tree, and female urinary tract should be done once there is a suspicion of ligneous conjunctivitis in order to check for pseudomembranes on those surfaces. It may be fatal if the airway is involved. Examining sun-exposed skin may also reveal juvenile colloid milium.

Prognosis:

The severity, duration, and afflicted place that causes symptoms all play a role in the prognosis for ligneous conjunctivitis. The capacity to manage inflammation and the recurrence of false membranes will determine the outcome. Patients with corneal involvement have a worse prognosis for vision. A lot of patients have made it to maturity. Significant morbidity was reported by many patients, including the loss of function of an affected organ, such as vision loss or dentition loss. Life-threatening respiratory failure may result from systemic involvement of the respiratory tract with pseudo-membranes. The treatment and prevention of these lesions and their consequences are necessary for this group of individuals. Untreated people with substantial diseases do not have the best quality of life.

Homeopathic Treatment for the Disease:

Regarding the curative method for ligneous conjunctivitis, there is no agreement. Numerous treatment paradigms have been investigated, and the majority of case reports show that using a combination of medicinal and surgical therapy can reduce recurrence. Following surgical excision, a prolonged, demanding topical heparin course, which is curtailed once wound healing is complete, and a topical fibrinolytic agent such as plasminogen or plasminogen activator were recommended by Schuster and Seregard (2003) recommended using in their review of the literature on the treatment of ligneous conjunctivitis from 1966 to 2002.

To reduce inflammation, corticosteroids applied topically with or without external cyclosporine may be added. Topical plasminogen therapies, topical and subconjunctival pure frozen plasma, and fibrinolytic medications can all be used to treat ligneous conjunctivitis. Homeopathic medications take the whole individual into account rather than just the symptoms, acting constitutionally. The following are a few treatments for ligneous conjunctivitis:

• LACHESIS
• Argentum nit
• Thuja occ.
• ARNICA MONTANA
• APIS MELLIFICA
• BOTHOROPS
• VIPERA
• HAMAMELIS VIRGINICA

Precautions:

Anti-allergy drugs, such as antihistamines, are typically effective in treating allergic conjunctivitis. You should try to stay away from the substance that caused the allergy. It is preferable to wait until the signs have subsided before wearing contact lenses. The eyelids and lashes can be cleaned with cotton wool and water if they have any sticky or crusty buildup. It can be stopped from spreading by constantly washing your hands and refraining from sharing towels or pillows.