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 View this table: Table 1 Review of previously published cases of actinic granuloma 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. A 67 year old white woman presented to the ophthalmology department with a 3 week history of a painless, red right eye. She had no previous ophthalmic problems. Significant past medical history included treated pulmonary tuberculosis and a lumpectomy for breast carcinoma 10 years previously. She had no …