“Mucus fishing syndrome”: Presentation of this rare clinical entity along with its therapeutic options

Abstract

Aims/Purpose: The “Mucus fishing syndrome” (MFS) is a rare chronic inflammatory condition involving the ocular surface characterized by the continuous formation, of mucus filaments. The clinical presentation is variable and various underlying ocular surface pathologies including dry eye, blepharitis and allergic conjunctivitis can be associated. Chronic irritation, conjunctival hyperaemia and mucus production are present. On physical examination, patients may present an iatrogenic damage of the conjunctival epithelium due to the mechanical removal of mucus and a vicious circle is usually established which causes further conjunctival irritation and more conspicuous mucous secretion. The treatment involves the elimination of abnormal mucus production and the education of the patient to avoid contact with the ocular surface during the manoeuvres. We present a case of MFS in a young woman affected by meibomian gland dysfunction.Methods: The diagnosis was reached due to the presence of persistent mucous discharge and the characteristic rose bengal staining pattern. Initial supportive treatment (Tear substitutes and continuous irrigation of the ocular surface) prescribed elsewhere did not provide clear clinical benefits. Therefore, upon presentation a new approach was pursued adding to the ongoing treatment hydrocortisone eye drop 3 times a day, and a mucolytic agent (5% acetylcysteine eye drop) 4 times a day, together with accurate eyelid hygiene (morning and evening). Patient was also informed to avoid mechanical removal of the mucous.Results: One month after therapy the presence of mucus was reduced and the symptoms improved.Conclusions: Mucus fishing syndrome is a rare but challenging condition affecting the ocular surface. The objective of the therapy should address the pharmacological lysis of the mucous produced along with the instruction of patient not to compulsively remove the filaments in order to avoid further stress and accelerate healing.