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Corneal Mucous Plaques Treatment & Management

  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Jun 14, 2016
 

Medical Care

The use and concentration of topic mucolytic agents, such as acetylcysteine, should be individualized to the severity of the disease and symptoms. Topically applied 10-20% acetylcysteine drops 1-4 times daily can rapidly loosen the adherent plaque by dissolving the mucoid component. Continued therapy may result in plaque recurrence. Plaques may still occur in patients receiving acetylcysteine treatment, but the mucous adherence is usually weaker and the plaques are shorter-lived than those formed in the absence of mucolytic therapy.

Mucous plaques causing more severe symptoms may be mechanically retrieved by scraping with a spatula, pulling with forceps, or debriding with a cotton swab or Weck-cel sponge. A bandage soft contact lens applied to the cornea may both enhance patient comfort and prevent recurrence. However, because of frequently associated keratoconjunctivitis sicca, tear film abnormalities, and contact lens deposit formation, the bandage contact lens may need frequent replacement or cleaning.[7] Plaques also may recur if the bandage contact lens is discontinued.

Staphylococcal blepharitis may predispose patients to corneal mucous plaque formation. Therefore, when appropriate, treatments should include adequate control of associated local microbial infection and colonization.

Artificial tear preparations may be indicated for the treatment of dry eye. In the presence of filamentary keratitis and the formation of excessive mucus, hypotonic artificial tear substitutes (rather than the viscous type of tear substitutes) may be combined with acetylcysteine. The use of preservative-free tear substitutes or lubricants is preferable due to the epithelial toxicity exhibited by many ophthalmic preservatives, such as benzalkonium chloride, chlorobutanol, and thimerosal.[8]

Delayed plaques and pseudodendrites associated with herpes zoster may be responsive to certain antiviral therapy.[6]

Excimer laser phototherapeutic keratectomy has been demonstrated as a useful adjunct to the treatment of shield-shaped keratoconjunctivitis.[9, 10]

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Contributor Information and Disclosures
Author

Robert H Graham, MD Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, Arizona Ophthalmological Society, American Medical Association

Disclosure: Partner received salary from Medscape/WebMD for employment.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, International Society of Refractive Surgery, Cornea Society, Eye Bank Association of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Fernando H Murillo-Lopez, MD Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor, Roddy Frankel, MD, PhD, to the development and writing of this article.

References
  1. Fraunfelder FT, Wright P, Tripathi RC. Corneal mucus plaques. Am J Ophthalmol. 1977 Feb. 83(2):191-7. [Medline].

  2. Liesegang TJ. Corneal complications from herpes zoster ophthalmicus. Ophthalmology. 1985 Mar. 92(3):316-24. [Medline].

  3. Marsh RJ, Fraunfelder FT, McGill JI. Herpetic corneal epithelial disease. Arch Ophthalmol. 1976 Nov. 94(11):1899-1902. [Medline].

  4. Golubovic S, Parunovic A. Vernal conjunctivitis--a cause of corneal mucoid plaques. Fortschr Ophthalmol. 1986. 83(3):272-4. [Medline].

  5. Marsh RJ, Cooper M. Ophthalmic zoster: mucous plaque keratitis. Br J Ophthalmol. 1987 Oct. 71(10):725-8. [Medline].

  6. Pavan-Langston D, Yamamoto S, Dunkel EC. Delayed herpes zoster pseudodendrites. Polymerase chain reaction detection of viral DNA and a role for antiviral therapy. Arch Ophthalmol. 1995 Nov. 113(11):1381-5. [Medline].

  7. Tripathi RC, Tripathi BJ, Silverman RA, Rao GN. Contact lens deposits and spoilage: identification and management. Int Ophthalmol Clin. 1991 Spring. 31(2):91-120. [Medline].

  8. Tripathi BJ, Tripathi RC, Kolli SP. Cytotoxicity of ophthalmic preservatives on human corneal epithelium. Lens Eye Tox Res. 1993. 9:361-74.

  9. Autrata R, Rehurek J, Holousova M. [Phototherapeutic keratectomy in the treatment of corneal surface disorders in children]. Cesk Slov Oftalmol. 2002 Apr. 58(2):105-11. [Medline].

  10. Cameron JA, Antonios SR, Badr IA. Excimer laser phototherapeutic keratectomy for shield ulcers and corneal plaques in vernal keratoconjunctivitis. J Refract Surg. 1995 Jan-Feb. 11(1):31-5. [Medline].

  11. Doughty MJ. Impact of brief exposure to balanced salts solution or cetylpyridinium chloride on the surface appearance of the rabbit corneal epithelium--a scanning electron microscopy study. Curr Eye Res. 2003 Jun. 26(6):335-46. [Medline].

  12. Shaw EL, Gasset AR. Management of an unusual case of keratitis mucosa with hydrophilic contact lenses and N-acetylcysteine. Ann Ophthalmol. 1974 Oct. 6(10):1054-6. [Medline].

 
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