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Nature Editorial: Ophthalmic manifestations of monkeypox virus - July 2022

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  • Nature Editorial: Ophthalmic manifestations of monkeypox virus - July 2022

    Published: 27 July 2022


    Abdelaziz Abdelaal, Hashem Abu Serhan, Mariam Abdelmageed Mahmoud, Alfonso J. Rodriguez-Morales & Ranjit Sah

    ... The clinical picture of the MPXV is very similar to that of the ordinary and modified forms of smallpox [5, 6]. Lymphadeno- pathy, occurring in the early stage of the illness, is a distinctive hallmark differentiating human monkeypox from smallpox and chickenpox [5, 6]. MXPV has been reported to have several ophthalmic manifestations which are common like other non- specific symptoms (i.e., fatigue, headache, muscle ache) [5, 6]. For instance, the characteristic lesions of MPXV usually appear as first macular, then papular, then vesicular and pustular which often involve peri-orbital and orbital skin, resembling Varicella-Zoster rash, which affect 25% of cases [7]. A full list of ophthalmological manifestations of MPXV is provided in Table 1.

    Conjunctivitis and edema of the eyelids were common (approximately over 20% of affected patients) and resulted in substantial but temporary distress to the affected patients [5, 7–9]. Interestingly, Jezek Z et al. [10] showed that conjunctivitis was more common among patients affected by animal MPXV (20.3%) compared to those affected by human MPXV (16.4%). Further- more, focal lesions on the conjunctiva and along the margins of the eyelids were seen with a greater incidence among unvacci- nated patients with confirmed MPXV (nearly 25%, 68/294) [5, 11]. Hughes et al. [9] reported that patients, where “conjunctivitis” was observed, had a higher frequency of other symptoms, such as nausea, chills/sweating, oral ulcers, sore throat, general malaise, lymphadenopathy, and photophobia compared to those with no reported “conjunctivitis”. In addition, conjunctivitis is likely predictive of the illness course. For example, 47% of patients with conjunctivitis reported being “bed-ridden”, compared to 16% of patients where “conjunctivitis” was not reported [9].

    Corneal involvement may range from mild to severe involve- ment. Photophobia, alone, was reported in approximately 22% of affected patients [7]. In addition, severe corneal infections that can result in severe keratitis forms (seen in 7.5% of patients in one study), corneal scarring (seen in 4% of unvaccinated, and 1% of previously smallpox-vaccinated case patients), and permanent vision loss were also reported [6–8, 10]. Based on the study of Jezek et al. [10], unilateral or bilateral blindness, and weak vision were observed in 10% of primary (who presumably were infected from an animal source) and 5% of secondary cases (in whom the rash appeared between 7 and 21 days after exposure to another human case which may have occurred due to person-to-person transmission). Of note, Trifluridine has been used to treat Orthopoxvirus-associated corneal lesions. However, there is no available evidence of its efficacy in MPXV cases specifically [9]. We should not forget to mention that MPXV causes lymphadenopathy, which may involve pre-auricular lymph nodes as seen in viral conjunctivitis [5–8, 12]. Frontal headache involving the orbits was also reported [5, 6, 8, 12]. Furthermore, one study showed that blepharitis was observed in 30% of unvaccinated, and in 7% of previously smallpox- vaccinated patients [13]. ...

  • #2

    As highlighted in the twitter post "A big upto 30% of patients of #monkeypox have eye lesions from painful, swollen eyelids to permanent scarring of the cornea & permanent blindness in 10%". I cannot find anything that indicates that you won't get lesions if not in contact with other lesions/fomites. Is there any evidence that "not touching your eyes" and ensuring that nothing contaminated touches your eyes would help cut down the number of lesions people are getting in their eye area? This is a really awful long term consequence of a pandemic out of control and given wings by health professionals labelling it as an std.
    "The only security we have is our ability to adapt."


    • #3
      A Must Read