Spectrum of ophthalmic manifestations in monkeypox virus infection worldwide: Systematic review and meta-analysis

Abstract

Mpox virus infection is a significant public health concern worldwide due to its potential severity and the likelihood of outbreaks occurring across different regions. Ophthalmic manifestations of the disease have been linked with more severe cases, leading to the need for hospitalization and antiviral therapy. A systematic review and meta-analysis were conducted following PRISMA guidelines to summarize the literature available on this topic. The review revealed that ophthalmic manifestations, such as conjunctivitis and periocular umbilicated lesions, are the most common in Mpox virus infections. However, severe manifestations, such as corneal opacity, that can potentially cause blindness may also occur. Antiviral treatment with tecovirimat and topical management for conjunctivitis can be considered for severe cases. However, the evidence quality is poor due to the predominance of case reports and imprecise characterization of the ophthalmic manifestations. Overall, ophthalmologists and healthcare professionals should be aware of these manifestations for early diagnosis and timely treatment.

Keywords: Monkeypox virus; Mpox; Mpox virus; Ocular infection; Ocular inflammation; Ophthalmology; Uveitis, Scleritis, Conjunctivitis, Treatment.

Fig. 1

PRISMA flow diagram for selected studies included in the systematic review.

Fig. 2

Meta-analysis of proportion for the more common ophthalmic manifestations of mpox. A. Eyelid lesions. B. Conjunctivitis. C. Conjunctival lesions. D. Preseptal cellulitis. E. Keratitis.

Fig. 3

Funnel Plot for the meta-analysis of conjunctivitis. Fail-safe N analysis (Fail-safe N = 4143.000, p < 0.001), Rank Correlation Test (Tau = 0.278, p = 0.071), Asymmetry (Z = 4.988, p < 0.001).

Fig. 4

Meta-analysis comparing the risk of ophthalmic manifestation between vaccinated and unvaccinated subjects.