Mucus fishing syndrome: clinical spectrum and update on its multifactorial pathogenic mechanisms

To analyze the clinical spectrum of mucus-fishing syndrome (MFS), an often-overlooked cause of dry eye disease, marked by a vicious cycle of self-induced ocular surface irritation and mucus overproduction.

Retrospective observational case series study.

A total of 29 patients with MFS were included. Most patients were female (89.6%) with a mean age of 54.3 ± 18.5 years. Psychological and psychiatric comorbidities were reported in 31.0% of the patients, with anxiety and depression being the most common. Patients primarily used their fingernails (82.7%) for filament removal, along with other methods including cotton swabs, paper tissues, and needles. Common symptoms included an imminent feeling of mucus removal (100%), foreign body sensation (96.5%), tearing (51.7%), and a red eye (41.3%). Treatment focused on patient education, ocular surface management, and adjuvant therapies, achieving favorable responses in 55.1% of the patients within the first month.

MFS is an insidious cause of dry eye syndrome that may be underdiagnosed because of patient embarrassment and limited clinician awareness. Effective management requires patient education to avoid filament removal and to address the underlying ocular and mental health conditions.