Conjunctivitis with Monkeypox Virus Positive Conjunctival Swabs

Meduri, Enrico; Malclès, Ariane; Kecik, Mateusz

doi:10.1016/j.ophtha.2022.07.017

Cited by 24 publications

(41 citation statements)

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“…In this current global outbreak, reported ocular complications have been rare compared to previous epidemics [5] . At present, case series’ and reports have identified cases of ocular involvement in Italy, Spain, the United Kingdom, the United States, and Switzerland [2] , [4] , [6] , [7] , [8] . Clinical features of these cases have included lesions of the eyelids, blepharoconjunctivitis, and a conjunctival ulcer [6] , [7] , [8] .…”

Section: Discussionmentioning

confidence: 99%

“…At present, case series’ and reports have identified cases of ocular involvement in Italy, Spain, the United Kingdom, the United States, and Switzerland [2] , [4] , [6] , [7] , [8] . Clinical features of these cases have included lesions of the eyelids, blepharoconjunctivitis, and a conjunctival ulcer [6] , [7] , [8] . None have reported more severe potential complications, such as keratitis.…”

Section: Discussionmentioning

confidence: 99%

“…Currently the management of MPX-associated eye disease has largely been symptomatic and supportive. As yet, no role for topical antiviral therapy has been demonstrated [1] , [6] , [7] , [8] . Ocular localisation of MPX via self-inoculation has been postulated, suggesting the need to provide hygiene education to patients to prevent ophthalmic involvement [7] .…”

Section: Discussionmentioning

confidence: 99%

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Ocular manifestation of monkeypox virus in a 38-year old Australian male

Alexis

Hohnen

Kenworthy

et al. 2022

IDCases

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ocular manifestation of monkeypox virus in a 38-year old Australian male

Alexis

Hohnen

Kenworthy

et al. 2022

IDCases

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“…Much of what is known about MPXROD draws from previous outbreaks, and detailed clinical descriptions of MPXROD are unfortunately limited. 1,[21][22][23][24][25][26][27] However, the present outbreak is of clade II, while much of the available literature regarding MPXROD relates to prior clade I outbreaks. 19,[28][29][30] Epidemiologic differences in the current outbreak (such as the predominance in MSM and rare pediatric occurrence) 11 in comparison with previous outbreaks have been noted, and differences in the spectrum of ocular manifestations and frequency of ocular disease may also emerge.…”

Section: Monkeypox-related Ophthalmic Disease Manifestationsmentioning

confidence: 99%

“…23 Monkeypox conjunctivitis may include a conjunctival follicular reaction, discrete vesicular or papular conjunctival lesions, conjunctival ulceration, pseudomembranes, and/or subconjunctival nodules. 21,23,[25][26][27]31 In the 2010 to 2013 outbreak of clade I in the Democratic Republic of the Congo, patients with conjunctivitis had higher rates of systemic symptoms (nausea, fatigue, lymphadenopathy, chills/sweating) and of being "bedridden." 29 Corneal disease in the setting of monkeypox can include ulcerative keratitis, immune stromalkeratitis,andneurotrophickeratitis 24 andmayresultincornealscarring and bacterial superinfection.…”

Section: Monkeypox-related Ophthalmic Disease Manifestationsmentioning

confidence: 99%

Monkeypox Virus and Ophthalmology—A Primer on the 2022 Monkeypox Outbreak and Monkeypox-Related Ophthalmic Disease

2023

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ImportanceAn ongoing global monkeypox virus outbreak in 2022 includes the US and other nonendemic countries. Monkeypox ophthalmic manifestations may present to the ophthalmologist, or the ophthalmologist may be involved in comanagement. This narrative review creates a primer for the ophthalmologist of clinically relevant information regarding monkeypox, its ophthalmic manifestations, and the 2022 outbreak.ObservationsMonkeypox virus is an Orthopoxvirus (genus includes variola [smallpox] and vaccinia [smallpox vaccine]). The 2022 outbreak is of clade II (historically named West African clade), specifically subclade IIb. In addition to historic transmission patterns (skin lesions, bodily fluids, respiratory droplets), sexual transmission has also been theorized in the current outbreak due to disproportionate occurrence in men who have sex with men. Monkeypox causes a characteristic skin eruption and mucosal lesions and may cause ophthalmic disease. Monkeypox-related ophthalmic disease (MPXROD) includes a spectrum of ocular pathologies including eyelid/periorbital skin lesions, blepharoconjunctivitis, and keratitis). Smallpox vaccination may reduce MPXROD occurrence. MPXROD seems to be rarer in the 2022 outbreaks than in historical outbreaks. MPXROD may result in corneal scarring and blindness. Historical management strategies for MPXROD include lubrication and prevention/management of bacterial superinfection in monkeypox keratitis. Case reports and in vitro data for trifluridine in other orthopoxviruses suggest a possible role for MPXROD. Tecovirimat, cidofovoir, brincidofovir and vaccinia immune globulin intravenous may be used for systemic infection. There is a theoretical risk for monkeypox transmission by corneal transplantation, and the Eye Bank Association of America has provided guidance. Smallpox vaccines (JYNNEOS [Bavarian Nordic] and ACAM2000 [Emergent Product Development Gaithersburg Inc]) provide immunity against monkeypox.Conclusions and RelevanceThe ophthalmologist may play an important role in the diagnosis and management of monkeypox. MPXROD may be associated with severe ocular and visual morbidity. As the current outbreak evolves, up-to-date guidance from public health organizations and professional societies are critical.

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