Ophthalmic molluscum contagiosum is a skin infection that specifically appears on the eyelids or the skin directly surrounding the eyes. It is caused by the molluscum contagiosum virus (MCV), a member of the poxvirus family. This condition is common, particularly in children, and presents as small, distinct bumps on the skin’s surface. While the infection is generally confined to the epidermis, its location near the eye introduces specific considerations that distinguish it from molluscum found on other parts of the body.
Symptoms and Appearance
The primary sign of ophthalmic molluscum contagiosum is the appearance of one or more small, raised bumps, known as papules, on the eyelid or nearby skin. These lesions are typically round, firm, and dome-shaped, ranging in size from 2 to 5 millimeters. They are often flesh-colored or pink and have a characteristic pearly or waxy look. A defining feature is a central pit or dimple, known as umbilication.
The lesions can appear as a single bump or in small clusters. When located on the eyelid itself, a papule might resemble a small water blister. While the bumps themselves are often painless, they can become itchy or irritated.
Beyond the skin lesions, the presence of molluscum on an eyelid can cause ocular irritation. Individuals may experience redness, excessive tearing, light sensitivity, or a gritty feeling in the eye. These symptoms are a reaction to the virus, not the bumps themselves. Inflammation of the skin surrounding the papules may also occur, which is considered an immune response to the infection.
Transmission and Prevention
The molluscum contagiosum virus spreads through several methods, making awareness of its transmission routes important for prevention. The virus most commonly passes through direct skin-to-skin contact with an infected person. This is why the infection is frequently seen among children in settings like daycare or school.
Transmission also occurs through contact with contaminated objects, as the virus can survive on surfaces. It can be spread by sharing personal items like towels, pillows, or bath toys. Transmission is often more likely in wet environments, like swimming pools or shared baths, where the virus can spread more easily.
A person with molluscum can also spread the infection to other parts of their own body, a process called autoinoculation. This happens when an individual scratches or rubs a lesion and then touches an uninfected area of their skin, such as their eye. To prevent spreading the virus, wash hands frequently and avoid sharing personal items that touch the face. Covering lesions with a bandage can prevent direct contact, and individuals should avoid touching or scratching the bumps.
Ocular Complications
The location of molluscum contagiosum on or near the eyelid is a particular concern because of the potential for secondary eye problems. These complications arise when viral particles from the eyelid lesions shed into the tear film. This can trigger an immune reaction, leading to inflammation separate from the initial skin infection.
The most frequent ocular complication is chronic follicular conjunctivitis. This is an inflammation of the conjunctiva, the transparent membrane that lines the inside of the eyelids and covers the white part of the eye. In this condition, the inflammation causes the formation of small, organized bumps, or follicles, on the inner surface of the eyelids. This can lead to persistent eye redness, discharge, and irritation.
In some cases, more serious issues can develop. The inflammation can extend to the cornea, the clear front surface of the eye, a condition known as keratitis. This may present as fine epithelial keratitis, where the outermost layer of the cornea becomes inflamed. Because corneal inflammation can affect vision, any molluscum lesions on the eyelid warrant medical evaluation to manage these secondary effects.
Medical Treatments
While molluscum on other parts of the body may be left to resolve on its own, ophthalmic molluscum is treated more actively to prevent ocular complications. The goal is to remove the eyelid lesions, which stops the shedding of viral particles and allows the eye inflammation to resolve.
Several in-office procedures can be performed by an ophthalmologist or dermatologist to remove the lesions. Simple surgical excision involves cutting the lesion out, while curettage is a procedure where the bump is scraped off the skin’s surface. Another common method is cryotherapy, which uses liquid nitrogen to freeze and destroy the lesion. Due to the delicate nature of the eyelid area, these procedures must be performed by a medical professional.
Prescription topical medications are also an option. These creams and solutions work by breaking down the infected skin cells, allowing the immune system to clear the virus. Over-the-counter wart removers and other home remedies should not be used near the eyes, as they can cause significant harm. Attempting to remove the lesions at home by squeezing or scraping is strongly discouraged, as it can lead to infection, scarring, and further spread of the virus.