Which condition is characterized by a woody membranous plaque on the superior tarsal conjunctiva due to plasminogen deficiency?

• A. Ligneous conjunctivitis
• B. Vernal keratoconjunctivitis
• C. Angular conjunctivitis
• D. Conjunctival nevus

Answer: (A)

This question hinges on recognizing ligneous conjunctivitis. The defining feature is the formation of woody, membranous plaques on the conjunctiva, most commonly on the superior tarsal conjunctiva, caused by plasminogen deficiency. Plasminogen normally helps convert to plasmin to break down fibrin. When its activity is deficient, fibrin accumulates and forms firm, wood-like pseudomembranes on mucous membranes, including the conjunctiva. These membranes are characteristically thick, tough, and recurrent, and can involve other mucous membranes as well.

Other conditions described don’t fit this pattern. Vernal keratoconjunctivitis is an allergic process with giant papillae and itching, not woody fibrinous membranes from fibrinolysis failure. Angular conjunctivitis occurs at the lid commissures with fissures and discharge, not a tarsal, plaque-like lesion. Conjunctival nevus is a pigmented lesion, not a membrane plaque due to plasminogen deficiency.

So the woody membranous plaque on the superior tarsal conjunctiva driven by plasminogen deficiency is characteristic of Ligneous conjunctivitis.