Molluscum Contagiosum!
-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:
-Healthy patients - self-limiting
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:
-Good hygiene habits
COMPLICATION:
-MC - Secondary bacterial infection
Image from Rajan Eye Care Hospital
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