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

The paucity of reports ensures that the condition is under-recognised both clinically and pathologically. We describe a further case with the novel association of scleral thinning, and further review the literature with reference to pathogenesis, disease associations, treatment, and significance for both ophthalmologists and pathologists.