The lid lesion is an epidermal viral infection caused by the DNA poxvirus Molluscum Contagiosum
Virus (MCV). It will typically present with multiple, small (1-3 mm), discrete, dome-shaped skin
nodules. There is usually no surrounding inflammation but with umbilicated center filled with
cheese-like or waxy material. Not uncommonly, there will be multiple other lesions elsewhere on
the body.
It is commonest in children 1-4 yo or in immune-compromised adults ( ie. HIV, AIDS or on immune-
suppressants such as steroids, methotrexate). It is mildly contagious and spread by skin to skin
contact. Children with eczema or attendances to swimming pool are associated with higher risk of
contracting the virus.

Viral protein of the MCV shed from the lid lesions into the tear film and lead to a secondary chronic
follicular reaction. This in turn can cause punctate keratopathy, and in some cases subepithelial
opacities and pannus.

The skin lesions are largely self-limiting and usually resolve spontaneously within a few months
without long term sequelae. Therefore, treatment will depend on severity on presentation.
If the lesion is quiet and not associated with follicular conjunctivitis, the best option is to observe
and to provide general advice such as need for personal hygiene to prevent re-infection and
spreading.
If the lesion is causing recurrent follicular conjunctivitis and ocular surface disease, shave excision or
cauterisation can be used to speed up the healing process.