Predisposing factors

Epidemiological studies have shown separate associations with attendance at swimming pools, and with eczema

Strong association with Human Immunodeficiency Virus (HIV) infection

Symptoms of molluscum contagiosum

Presence of skin lesion(s)
Ocular symptoms: redness, watering, photophobia, blurring of vision (all mild)

Signs of molluscum contagiosum

Skin nodule(s) (typically 2-3 mm diameter), often with a central depression (‘umbilicated’)
No visible inflammation
Central core has cheese-like or waxy material which may discharge spontaneously
May be single or multiple on the lid(s) and/or elsewhere on the body
Ocular signs (usually unilateral):

• hyperaemic conjunctiva
• conjunctival follicles
• corneal involvement including punctate keratopathy, subepithelial opacities and pannus
• watery discharge

No lymphadenopathy

Differential diagnosis

Other lesions of the lids which may be skin-coloured:

• basal cell carcinoma, neurofibroma, sebaceous adenoma, non-pigmented intradermal naevus, squamous cell papilloma, chalazion, cutaneous horn, sebaceous carcinoma

Other causes of follicular conjunctivitis:

• viral: herpes simplex, adenovirus, chicken pox lesions around eye
• chlamydia
• topical medication (conjunctivitis medicamentosa)
• Parinaud’s oculo-glandular syndrome

Management by optometrist

Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere

Usually self-limiting (weeks or months) without scarring or other long term sequelae.  Although no reliable evidence-based recommendations can be given for the treatment of molluscum contagiosum at present, clinical consensus would support active intervention for lesions of the lid margin causing follicular conjunctivitis or corneal involvement e.g. superficial keratitis/pannus .
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

If lesion is quiet (dry central core) and no ocular signs or symptoms:

• leave alone
• advise on need for hygiene to prevent reinfection and spread to others

(GRADE*: Level of evidence=moderate, Strength of recommendation=strong)

Artificial tears and lubricating ointment (drops for use during the day, unmedicated ointment for use at bedtime) may relieve symptoms in follicular conjunctivitis
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

Management category

B2: Alleviation / palliation: normally no referral
B1: Routine referral to ophthalmologist if:

• multiple peri-ocular lesions
• lesions on the lid margin
• follicular conjunctivitis

Possible management by ophthalmologist

Possible destruction of lesion by shave excision, cautery, cryotherapy or incision and curettage

Evidence base

*GRADE: Grading of Recommendations Assessment, Development and Evaluation (www.gradeworkinggroup.org)
 

Sources of evidence

Chen X, Anstey AV, Bugert JJ. Molluscum contagiosum virus infection. Lancet Infect Dis. 2013;13(10):877-88

Gonnering RS, Kronish JW. Treatment of periorbital Molluscum contagiosum by incision and curettage. Ophthalmic Surg. 1988;19(5):325-7.

Olsen JR, Gallacher J, Piguet V, Francis NA. Epidemiology of molluscum contagiosum in children: a systematic review. Fam Pract. 2014;31(2):130-6

Schornack MM, Siemsen DW, Bradley EA, Salomao DR, Lee HB. Ocular manifestations of molluscum contagiosum. Clin Exp Optom. 2006;89(6):390-3.

van der Wouden JC, van der Sande R, Kruithof EJ, Sollie A, van Suijlekom-Smit LWA, Koning S. Interventions for cutaneous molluscum contagiosum. Cochrane Database of Systematic Reviews 2017;5(5):CD004767. 

Molluscum contagiosum 
Version 10
Date of search 10.02.23
Date of revision 23.03.23
Date of publication 26.05.23
Date for review 09.02.25
© College of Optometrists