A Review of Monkeypox Ocular Manifestations and Complications: Insights for the 2022 Outbreak
Monkeypox (MPVX) infection has been associated with multiorgan presentations. Thus, monkeypox infection’s early and late complications are of particular concern, prompting health systems to decipher threatening sequels and their possible countermeasures. The current article will review the clinical signs and symptoms of the present and former outbreaks, differential diagnoses, workup and treatment of the ocular manifestations of MPXV infection in detail. One of the uncommon yet considerable MPXV complications is ocular involvement. These injuries are classified as (1) more frequent and benign lesions and (2) less common and vision-threatening sequels. Conjunctivitis, blepharitis and photophobia are the most uncomplicated reported presentations. Moreover, MPXV can manifest as eye redness, frontal headache, orbital and peri-ocular rashes, lacrimation and ocular discharge, subconjunctival nodules and, less frequently, as keratitis, corneal ulceration, opacification, perforation and blindness.
This article reviews the clinical signs, symptoms, differential diagnoses, workup, and treatment of ocular manifestations of monkeypox (MPXV) infection, highlighting both early and late complications. Ocular involvement, while uncommon, can range from benign lesions like conjunctivitis and blepharitis to vision-threatening sequels such as keratitis, corneal ulceration, opacification, and even blindness. The review emphasizes that ocular manifestations appear to be less frequent and severe in the current outbreak compared to previous outbreaks in endemic countries, where incidence rates were significantly higher.
The history of smallpox immunization seems to offer a protective effect against ocular complications from MPXV. While there is no definitive treatment, simple therapies like lubrication and prophylactic topical antibiotics may be considered for milder cases. Timely administration of specific antivirals may be effective in severe cases. The article underscores the importance of ophthalmologists being familiar with the ocular manifestations of MPXV.
In conclusion, monkeypox typically presents with mild to moderate severity and a self-limited course, but timely recognition and proper management of the disease, including its ocular complications, are crucial to reduce the risk of permanent sequelae and overall morbidity. Encouraging vaccination in high-risk populations is also emphasized due to the higher risk of severe complications in unvaccinated individuals.
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