Corneal Mucous Plaques Treatment & Management

  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 14, 2012
 

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  Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

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

Disclosure: WebMD/eMedicine Salary Employment

Specialty Editor Board

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.

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

Disclosure: Medscape Salary Employment

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 Institute

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

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; RPS Ownership interest Other; EyeGate Pharma Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting; Merck Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

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, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine 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. Feb 1977;83(2):191-7. [Medline].

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

  3. Marsh RJ, Fraunfelder FT, McGill JI. Herpetic corneal epithelial disease. Arch Ophthalmol. Nov 1976;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. Oct 1987;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. Nov 1995;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. Spring 1991;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. Apr 2002;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. Jan-Feb 1995;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. Jun 2003;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. Oct 1974;6(10):1054-6. [Medline].

 
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