Molluscum contagiosum (MC) is a common, benign skin condition resulting from a viral infection that typically resolves without intervention. It manifests as small, raised bumps and is most frequently observed in children, though it can affect people of any age. Ophthalmic molluscum contagiosum (OMC) occurs when these lesions develop on or immediately adjacent to the eyelid margin or periorbital skin. This location can lead to secondary inflammatory reactions in the eye itself, which is the primary concern for eye care professionals. Due to the proximity to the delicate ocular surface, specialized attention is often necessary to prevent complications.
The Viral Origin and Transmission
The infection is caused by the Molluscum Contagiosum Virus (MCV), a member of the Poxviridae family. MCV causes a localized skin infection only, infecting the keratinocytes, which are the cells of the outermost layer of the human skin.
Transmission occurs primarily through direct skin-to-skin contact, such as during close physical play or sexual activity. The virus can also spread indirectly via contaminated objects (fomites), which include shared towels or clothing. A significant mode of spread relevant to OMC is autoinoculation, where an individual inadvertently spreads the virus from an infected area on their body to the eye area by scratching or rubbing.
Children are disproportionately affected due to their close physical contact during play and immature immune systems. Individuals with compromised immune systems (such as those with HIV/AIDS) or underlying skin conditions like atopic dermatitis are also at a higher risk. In these populations, the lesions may be more numerous, larger, and persistent, requiring more aggressive management.
How the Infection Presents Around the Eye
The primary manifestation of ophthalmic molluscum contagiosum is the presence of one or more molluscum papules on the eyelid or surrounding skin. These lesions are typically small (2 to 5 millimeters) and have a distinct appearance: dome-shaped, firm, and flesh-colored or pearly white, with a characteristic central indentation or dimple called umbilication.
While the lesion itself is usually painless, its location near the eye causes the most significant issues. The viral material within the papule sheds into the tear film and washes across the surface of the eye, triggering a localized immune response on the ocular surface.
The most frequent secondary complication is follicular conjunctivitis, which presents as chronic eye irritation and redness due to lymphoid tissue clusters (follicles) forming on the conjunctiva. The prolonged presence of viral debris can also lead to punctate keratitis, a temporary inflammation of the cornea’s outermost layer that may cause light sensitivity and blurred vision. The lesions can also cause blepharitis, an inflammation of the eyelid margin characterized by scaling and crusting.
The eye symptoms persist because the immune system constantly reacts to the viral antigens released from the nearby eyelid lesion. Once the molluscum lesion is removed, the secondary inflammation of the conjunctiva and cornea typically begins to resolve over several weeks.
Medical Approaches to Treatment and Resolution
Diagnosis of ophthalmic molluscum contagiosum is usually made clinically based on the distinctive appearance of the umbilicated papule near the eye. In ambiguous cases, a biopsy may be performed to confirm the diagnosis by identifying the viral inclusion bodies, known as molluscum bodies, within the tissue. Treatment decisions are guided by the severity of secondary ocular inflammation and the proximity of the lesions to the eyelid margin.
Observation vs. Active Treatment
Because the infection is self-limiting in healthy individuals, one common approach is observation, often referred to as “watchful waiting.” While the immune system will eventually clear the virus, this process can take a prolonged period, ranging from several months up to five years. Since chronic eye inflammation may persist throughout that time, active treatment is generally recommended for OMC to quickly resolve the irritating eye symptoms.
Physical Removal Methods
Active intervention focuses on physically removing the lesion to immediately stop the shedding of viral particles into the tear film. Two primary physical methods are used: curettage (scraping the lesion off with a small surgical instrument) and cryotherapy (using liquid nitrogen to freeze and destroy the lesion). These procedures require extreme care and precision due to the delicate anatomy of the eyelid margin. They are often performed under magnified visualization to ensure complete removal of the viral core while minimizing trauma.
Topical Agents and Prognosis
Topical agents, such as cantharidin or specific retinoids, are sometimes used for molluscum on other parts of the body. Newer FDA-approved treatments like berdazimer have also emerged. However, their use directly on the eyelid or near the tear film is often limited due to the high sensitivity of the eye and the potential for chemical irritation. The prognosis for OMC is excellent; once the causative lesion is successfully eliminated, the chronic follicular conjunctivitis and associated corneal inflammation reliably clear up, and the risk of long-term vision impairment is low.