Heparin in the long-term management of ligneous conjunctivitis

Abstract

Ligneous conjunctivitis, secondary to inherited homozygous plasminogen deficiency, is a poorly understood condition that has the potential to hinder normal childhood development if not managed adequately. We report the clinical progression of a child with ligneous conjunctivitis, controlled with daily heparin eye drops, postsurgical excision, for a duration of approximately 5 years at a cost of approximately 30 USD per month. During this time, the patient's progress has been complicated by one occurrence of periorbital cellulitis and also otitis media. The patient has also experienced ocular complications due to the remaining membranous lesion. This case indicates that individual patient factors including plasminogen levels and exposure to triggers of ocular inflammation may influence the clinical progression of ligneous conjunctivitis. Furthermore, this study is one of the first to present over 5-year follow-up of a patient with ligneous conjunctivitis effectively managed with long-term heparin eye drops.

Ligneous cervicitis and endometritis: A gynaecological presentation of congenital plasminogen deficiency

“…8 Another case report of a 21-year-old patient with ligneous inflammation involving the female genital tract, oral mucosa and conjunctiva also noted an improvement in plasminogen activity with 5 months on the oral contraceptive but no clinical improvement. 9 Other reports have described successful treatment of plasminogen deficiency with ligneous conjunctivitis using topical direct thrombin inhibitor and fresh plasma 10 and a possible benefit from using heparin eye drops 11 and heparin and allogenic serum. 12 In one case report, a patient with ligneous gingivitis was started on warfarin 1 week after excision of ligneous gingival masses and did not have any recurrence 3.75 years after this.…”

Ligneous conjunctivitis in a patient of juvenile colloid milia: A rare association

“…Management includes topical plasminogen concentrate,[3] topical fresh frozen plasma,[5] with systemic fresh frozen plasma,[67] topical heparin,[58910] with topical corticosteroids or alpha chymotrypsin,[1] topical cyclosporine A with amniotic membrane,[10] systemic low-dose lys-plasminogen,[13] surgical excision of pseudomembrane, which has high recurrence rates.…”

Lignöz Konjonktivit: Olgu Serisi

“…Hastalığın ortaya çıkma yaşı ile ilgili olarak literatürde doğumdan 85 yaşa kadar olan aralıkta olgular bildirilmiştir, bizim olgularımızın ortalama tanı yaşı 22,17 ay idi. Bununla birlikte tanı yaşı 16 ayın üzerinde olan tek olgumuz (olgu 4 1,08 (25 olguda) olarak bildirmiştir. Lignöz konjonktivitin etyolojisi incelendiğinde plazminojen eksikliğinin önemli bir yer tuttuğunu görmekteyiz.…”

“…Heparin ve taze donmuş plazma kolay elde edilebilmesi, maliyetinin daha düşük olması nedeniyle gerek topikal gerekse sistemik kullanımda daha uygun alternatiflerdir. [1][2][3][4][5]9 Lignöz konjonktivit nadir görülen ancak remisyon ve nükslerle oldukça uzun süreli seyreden, morbiditesi yüksek bir hastalıktır. Olgu sayısının kısıtlı olmasından dolayı literatürde tedavi seçeneklerini birbiriyle karşılaştıran randomize kontrollü çalışmalar yoktur Bu nedenle hangi tedavinin daha üstün olduğunu söylemek mümkün değildir.…”