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]
Consultations
In patients with Sjögren syndrome, a rheumatology consult may be helpful.
