Smallpox, Vaccinia, and the Eye

Novel severe oculocutaneous manifestations of human monkeypox virus infection and their historical analogues

“… 4 Ophthalmic complications of smallpox (variolous ophthalmia) have included conjunctivitis, pustular eyelid rash, periorbital oedema, uveitis, and progressive corneal ulceration, although we could find no examples of periorbital gangrene. 4 , 15 , 16 , 17 As early as 1903, the mechanism for ocular involvement was debated: keratitis sometimes preceded or presented simultaneously with cutaneous eruption, supporting bloodstream transmission, whereas an obvious decrease in eye involvement with rigorous hand hygiene favored autoinoculation. 15 As is the case with monkeypox virus, a mixed mechanism might have been involved.…”

“…This autoinoculation most commonly causes a vesiculopustular eyelid rash with blepharoconjunctivitis. 17 Vaccinia virus can also replicate successfully in the corneal epithelium and stromal keratocytes and, like variola virus, cause ulcerative keratitis and perforation. 17 , 18 Similar to its relatives, variola virus and vaccinia virus, monkeypox virus appears capable of locally inoculating and replicating within corneal tissue.…”

“… 17 Vaccinia virus can also replicate successfully in the corneal epithelium and stromal keratocytes and, like variola virus, cause ulcerative keratitis and perforation. 17 , 18 Similar to its relatives, variola virus and vaccinia virus, monkeypox virus appears capable of locally inoculating and replicating within corneal tissue. In addition to more common presentations of mpox-related ophthalmic disease, providers should be aware of the potential for restrictive periorbital gangrene, corneal perforation, and globe compromise.…”