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Sir,

In spite of its name, molluscum contagiosum is an only mildly contagious viral skin infection. The infective agent is a large DNA poxvirus, which causes multiple, grouped, umbilicated papules, usually appearing on the trunk, face, and arms. Spread by autoinoculation is common. Eyelid involvement is commonly accompanied by follicular conjunctivitis, but a primary conjunctival lesion is very rare.

Case report

A healthy 6-year-old Caucasian boy was referred for a persistently red, but painless, right eye, of about 2 weeks' duration. A small lump had been noted on the epibulbar conjunctiva. There was no significant ocular or general medical history. Examination revealed normal visual acuity. There were no eyelid abnormalities. There was diffuse conjunctival injection of the right eye, with a small, 1 mm, brownish lump in the supero-temporal quadrant of the epibulbar conjunctiva. An adjacent limbal infiltrate was present, with a few punctate erosions of the central cornea. The attending emergency officer gave chloramphenicol ointment q.i.d., and betamethasone drops t.i.d.

By the time the boy and his sister were seen 2 days later by an ophthalmologist (RIM), they had both been found to have typical molluscum contagiosum tumours affecting their forearms. Diagnosis was made by their attending general practitioner on clinical grounds. The conjunctival injection, limbal infiltrates, and corneal erosions had cleared. However, the conjunctival lump was still present (Figure 1). Betamethasone drops were continued for another week.

Figure 1
figure 1

Showing the conjunctival lump still present.

Full size image

At 1 month after initial presentation the lump was smaller, and 3 months later it had entirely resolved, as had all the skin lesions.

Comment

Hindaal and van Bijsterveld1 described a case of primary conjunctival molluscum contagiosum in 1979, and reviewed the eight previously published case reports, 1903–1967. Two cases involving suppressed immunity have more recently been described, occurring with AIDS,2 and with systemic steroid treatment for atopic dermatitis.3 It is now recognised that molluscum contagiosum, with larger and more numerous lesions, is part of the AIDS spectrum.4

With the current escalation of AIDS worldwide, it is likely that conjunctival molluscum contagiosum will be seen more commonly in the future, and it should be recognised as a possibility when considering the aetiology of conjunctival nodules.