Mucus fishing syndrome: case report and new treatment option.
BACKGROUND
Mucus fishing syndrome (MFS) is a cascading cyclic condition characterized by continuous extraction of mucous strands from the eye. It is usually initiated by ocular irritation. In response to irritation, ocular surface cells produce excess mucus. A "snow balling" cycle begins when the patient extracts ("fishes") excess mucus from the ocular surface, thereby causing further irritation and a more-profound mucous discharge. To date, treatment includes eliminating the initiating element and educating the patient not to touch the eye when extracting the excess mucus,


METHODS
Presented is a case of mucus fishing syndrome initiated by dry eye. The patient's diagnosis, MFS, was identified by persistent mucous discharge, his admittance and demonstration of digitally extracting mucus from the ocular surface, and a characteristic rose bengal staining pattern. The conventional treatment initiated by using artificial tears for the dry eye condition and educating the patient not to touch the ocular surface did not provide relief from the excess mucous discharge. Therefore, a new approach to treatment was pursued. In order to break the cycle, a mucolytic agent and an antihistamine-mast cell stabilizer were prescribed, until the ocular surface healed. After treatment, the patient reported alleviation of symptoms and demonstrated improvement in ocular surface integrity by a profound reduction in rose bengal staining.


CONCLUSIONS
Mucus fishing syndrome is challenging to resolve with conventional treatment because it requires a certain level of psychological tolerance and perseverance from the patient. By eliminating the present mucus and diminishing mucous production pharmacologically, the practitioner is able to remove the stimulus for digital extraction and thus accelerate ocular surface healing. We present a proposed new treatment option for patients who are refractory to conventional treatments.
Slagle
W S
WS
Virginia Eye Clinic, Salem Veteran's Affairs Medical Center, 24153, USA. drs_slagle@yahoo.com
Slagle
A M
AM
Brough
G H
GH
D003553:Cystine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D003990:Dibenzoxepins / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D015352:Dry Eye Syndromes / Q000150:complications; D006634:Histamine H1 Antagonists / Q000627:therapeutic use*; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009093:Mucus / Q000378:metabolism*; D000069605:Olopatadine Hydrochloride; D012395:Rose Bengal; D013577:Syndrome
D003990:Dibenzoxepins; D006634:Histamine H1 Antagonists; D012395:Rose Bengal; D000069605:Olopatadine Hydrochloride; D003553:Cystine; C030905:N-monoacetylcystine