Tranexamic acid-induced ligneous conjunctivitis with renal failure showed reversible hypoplasminogenaemia

Abstract

Ligneous conjunctivitis is a rare severe conjunctivitis characterised by fibrin-rich, 'woody', pseudomembranes on the tarsal conjunctiva complicated by congenital hypoplasminogenaemia. A previous report suggested that ligneous conjunctivitis may result from tranexamic acid (TA)-induced 'secondary' hypoplasminogenaemia. However, the serum plasminogen level has not been confirmed in that scenario. We report for the first time a case of TA-induced ligneous conjunctivitis with reversible hypoplasminogenaemia. A 70-year-old woman developed a gastric ulcer that was treated with oral TA. After 5 weeks of treatment, the patient presented with bilateral pale yellow pseudomembranes on the palpebral conjunctivae. Haematological analysis showed hypoplasminogenaemia. We diagnosed ligneous conjunctivitis. TA was discontinued after 14 weeks after the gastric ulcer symptoms resolved. Six weeks after discontinuation of therapy, the pseudomembranes regressed and the serum plasminogen level returned to the normal range. TA should be considered a possible aetiology in the setting of unresolving ligneous conjunctivitis.

Figure 1

Upper palpebral conjunctiva after 6 weeks of tranexamic acid use. Pale yellow, thick pseudomembranes were observed in both eyes.

Figure 2

Upper palpebral conjunctiva 6 weeks after discontinuing tranexamic acid. There is dramatic improvement with only minimal pseudomembrane present at the left upper palpebral fornix of the conjunctiva.