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Published: 27 July 2022
DOI https://doi.org/10.1038/s41433-022-02195-z
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]. ...
DOI https://doi.org/10.1038/s41433-022-02195-z
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]. ...
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