Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.
Faculty of Medical Sciences, Ghent University, Ghent, Belgium.
Ophthalmic Genet. 2023 Feb;44(1):103-106. doi: 10.1080/13816810.2022.2092756. Epub 2022 Jun 29.
Ligneous conjunctivitis is a very rare form of pseudomembranous conjunctivitis with few published cases in literature. We aim to describe the ocular findings and treatment in an infant with ligneous conjunctivitis resembling preseptal cellulitis on presentation.
Case report of a 3-month-old girl who was referred to a tertiary centre for ophthalmic assessment due to progressive eyelid oedema with no response to initiated topical and systemic antibiotics. Ethical approval has been achieved from the local ethics committee of the Ghent University Hospital and informed consent has been obtained from the parents of the child.
Examination under general anaesthesia showed multiple, wood-like fibrinous pseudomembranes, originating from the conjunctiva, consistent with ligneous conjunctivitis. After careful removal of the coagulated exudate covering the cornea, a central corneal epithelial defect was evident without stromal infiltration. Histopathologic examination confirmed the predominance of fibrin within the pseudomembranes. Plasminogen activity was below the normal range. Genetic analysis did not identify a pathogenic variant in the PLG gene. The corneal epithelium re-epithelialised during the following days and the conjunctival lesions gradually subsided over the ensuing weeks whilst continuing heparin-containing artificial tears.
A high level of suspicion is warranted in atypical cases of preseptal cellulitis which show no response to antibiotic treatment. Particularly in young children, examination under general anesthesia is warranted to allow diagnosis of rare causes of secondary eyelid oedema. We report an infant with unilateral ligneous conjunctivitis who responded well to topical, commercially-available heparin-containing artificial tears treatment. This approach is an effective and easy first-line treatment option in this condition, particularly in milder phenotypes.
细菌性结膜炎是一种非常罕见的伪膜性结膜炎形式，文献中报道的病例很少。我们旨在描述一名婴儿的眼部表现和治疗方法，该婴儿在就诊时表现为类似于蜂窝织炎的细菌性结膜炎。
对一名 3 个月大的女婴进行病例报告，该女婴因进行性眼睑水肿而被转诊至三级中心进行眼科评估，尽管已开始使用局部和全身抗生素治疗，但未见改善。已获得根特大学医院当地伦理委员会的伦理批准，并获得了患儿父母的知情同意。
全身麻醉下检查显示，多个木质纤维状假膜起源于结膜，符合细菌性结膜炎。仔细清除覆盖角膜的凝固渗出物后，可见中央角膜上皮缺损，无基质浸润。组织病理学检查证实假膜内主要为纤维蛋白。纤溶酶原活性低于正常范围。基因分析未在 PLG 基因中发现致病变异。在接下来的几天中，角膜上皮重新上皮化，在接下来的几周中，随着继续使用含有肝素的人工泪液，结膜病变逐渐消退。
对于表现为非典型蜂窝织炎且对抗生素治疗无反应的病例，应保持高度怀疑。特别是在幼儿中，全身麻醉下检查是必要的，以允许诊断继发性眼睑水肿的罕见原因。我们报告了一名单侧细菌性结膜炎婴儿，对局部、市售的含有肝素的人工泪液治疗反应良好。在这种情况下，特别是在轻度表型中，这种方法是一种有效且易于实施的一线治疗选择。
