Molluscum Contagiosum

Cornea & Ocular Surface

Apr 23

The Molluscum Contagiosum virus (MCV) belongs to the Poxviridae family - enveloped, double stranded DNA.
Transmitted by direct contact with infected skin or fomites
Patients may also exhibit autoinoculation, in which the virus may spread to other parts of the body by touching a lesion, then touching the body elsewhere
There is a sexually transmitted variant
Ocular MC typically results in eyelid nodules, but can affect the conjunctiva through a hypersensitivity reaction leading to a chronic follicular conjunctivitis
Most commonly affects children ages 10 and younger

RISK FACTORS:

Immunocompromised individuals (HIV-infected persons, patients receiving immunosuppression)
Atopic dermatitis (due to frequent breaks in the skin)
Those who live in warm, humid climates and crowded living conditions

PATHOPHYSIOLOGY:

MCV infects the epidermis and replicates in the cytoplasm of cells, with a variable incubation period between 2-6 weeks.
Lesions on the eyelid skin may shed viral particles into the tear film, resulting in ocular surface involvement

SIGNS:

Eyelid - MC site of ocular lesions
Lesions may be single, multiple or clustered, 2 to 5 mm, pink or skin-colored, with a shiny umbilicated surface
Keratoconjunctivitis associated with MC is generally chronic and features marked follicular conjunctivitis along with punctate keratopathy and epithelial or subepithelial inﬁltrates

DIAGNOSIS:

History and clinical examination
Excision biopsy for confirmation - epidermal cells with large eosinophilic intracytoplasmic inclusion bodies - Henderson-Paterson bodies or molluscum bodies

MANAGEMENT:

MEDICAL:

Topical chemical agents, such as imiquimod, silver nitrate, and trichloroacetic acid
Oral cimetidine

MECHANICAL METHODS:

Cryotherapy, curettage, PDT, caterization and pulse dye laser therapy which is suggested for refractory cases
If chronic anterior segment involvement - lesion excision, by unroofing and curettage

PREVENTION: