Ligneous Conjunctivitis with Plasminogen Deficiency Treated with Topical Allogeneic Serum Drops: A Case Report

To report a case of refractory ligneous conjunctivitis (LC) in which topical allogeneic serum eye drops from a relative with proven serum plasminogen activity were effective.
A 12-year-old male complained of intractable swelling and hardness of all eyelids, with woody discharge. He had been followed up with similar complaints since he was 1 year old. Until his teenage years, his membranes were relatively mild and non-progressive with topical cyclosporine (0.05%), artificial tears (single dose), antihistamines, antibiotics, and prednisolone acetate during active periods. His symptoms have been aggravated by impending corneal epithelial erosions due to thick ligneous membranes under the upper eyelids for the last year. Since commercial plasminogen eye drops were unavailable, allogeneic serum eye drops were prepared from a plasminogen-rich relative of the patient after obtaining informed consent.
The patient’s and his 1st° relatives’ plasma plasminogen activities were determined by chromogenic assay, and only his mother’s brother had a plasma plasminogen activity of 98%. Therefore, allogeneic serum eye drops were prepared from his plasma and given qid in addition to topical cyclosporine bid and artificial tears qid. Inflammatory pseudomembranes regressed with a dramatic resolution of the swelling and redness of the upper eyelids. No new conjunctivitis attacks were encountered during the last year.
Plasminogen-rich allogeneic serum seems reasonable when there is no access to commercially available plasminogen eye drops for patients with intractable LC.