Molluscum contagiosum


Localised dermal infection caused by a poxvirus
Commonest in:

  • children up to the age of 14 years, with the highest incidence in the age range 1-4 years in the UK
    • prevalence approx. 7% in immunocompetent children
  • immuno-compromised adults 
    • up to 18% in adults with the human immunodeficiency virus (HIV)

Transmitted by skin-to-skin contact; mildly contagious

Lesions on the lid margins may shed viral toxins into the conjunctival sac, causing:

  • follicular conjunctivitis
  • uncommonly, corneal involvement

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:

Management by optometrist

Practitioners should work within their scope of practice, and where necessary seek further advice or refer the patient elsewhere

Non pharmacological

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 in secondary care or local primary/community pathways where available

Additional guidance may be available

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

Evidence base

*GRADE: Grading of Recommendations Assessment, Development and Evaluation (

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. 


What is Molluscum Contagiosum?

Molluscum contagiosum is a viral infection of the skin that occurs most commonly in children. It usually consists of a single or a small group of fluid-filled pimples which have an obvious central depression. These can appear on the eyelids or surrounding skin. If molluscum is close to the eye, it may cause a type of conjunctivitis. 

How is Molluscum Contagiosum managed?

Since the condition gets better by itself, the usual advice in patients with this condition is to watch it carefully and allow natural healing. However, molluscum removal may be recommended if there are several pimples near the eye, or if it occurs on the rim of the eyelid, or when there is conjunctivitis. Various surgical and medical treatments are available but there is no evidence that one type of treatment is better than another.

Last updated

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 

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