Actinic granuloma of the conjunctiva

Actinic granuloma is a condition characterised, histologically, by a preponderance of giant cells in close relation with damaged elastic fibres and the absence of necrobiosis, lipid, mucin, and palisading of the granuloma. 1 The term was coined in 1975 by O'Brien who described similar histological features in cutaneous lesions of patients with sun damaged skin. 2 Actinic elastosis is the hallmark of pingueculae and has been noted in association with a granulomatous reaction in only one previous report. 3 Over the past three decades, three cases of actinic granuloma of the conjunctiva have been documented in the literature (Table 1). 4- 6 Patient age (years) Sex Location Size of lesion Clinical presentation Differential diagnosis Case 1, Proia et al 4 38 Female Temporal bulbar conjunctiva 2 mm 3/52 History of painless red eye Vascularised pinguecula Case 2, Ferry et al 5 30 Female Temporal bulbar conjunctiva 2 x 3 mm 6/52 History of red eye Pingueculitis, contact lens reaction, conjunctival naevus Case 3, Steffen et al 6 39 Female Conjunctiva, site unknown Not known Not known Pingueculitis, Bowen's disease Case 4, Gallagher et al 67 Female Nasal bulbar conjunctiva 3 x 3 mm 3/52 History of painless red eye Bowen's disease, breast metastasis The paucity of reports ensures that the condition is under-recognised both clinically and pathologically.