Factitious disorders include a spectrum of self-induced injuries with symptoms or physical findings. Factitious conjunctivitis usually shows evidence of mechanical injury to the inferior and nasal quadrants of the cornea and conjunctiva. The areas of involvement show sharply delineated borders. The conjunctival tissues usually show no evidence of inflammation on pathologic examination.
Mucus-fishing syndrome is characterized by a well-circumscribed pattern of rose bengal or lissamine green staining on the nasal and inferior bulbar conjunctiva. All patients have a history of increased mucus production as a nonspecific response to ocular surface damage. The inciting event is typically keratoconjunctivitis sicca. Patients usually demonstrate vigorous eye rubbing and compulsive removal of strands of mucus from the fornix (mucus fishing). The resultant epithelial injury heightens the ocular surface irritation, which in turn stimulates additional mucus production, resulting in a vicious cycle.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.