Ocular manifestations of mpox

Abstract

Purpose of review: To highlight the clinical features of mpox with an emphasis on ocular manifestations and to review treatment options for this re-emerging infectious disease.

Recent findings: Ocular involvement of mpox varies by clade. The most recent 2022 outbreak appears to be associated with fewer conjunctivitis cases compared to previous outbreaks. However, the ocular findings occurring during this newly emerging clade can be visually threatening and include cases of keratitis, rapidly progressing scleritis, and necrotizing periorbital rashes.

Summary: Ocular mpox is an important clinical feature of systemic mpox virus (MPXV) infection. Heightened clinical suspicion allows for a timely diagnosis and the initiation of antiviral treatment, when appropriate. Randomized clinical trials for mpox systemic and ocular treatment efficacy are lacking. Prior clinical experience with smallpox and in-vitro mpox data support the use of systemic antivirals such as tecovirimat, cidofovir, brincidofovir and topical use of trifluridine in ocular mpox management, though treatment-resistant infection can occur and portend a poor prognosis.

Figure 1.

Mpox Eyelid Vesicles. Active umbilicated pox lesions (left). Healing and crusted mpox lesions(right).[37]

Figure 2.

Mpox Associated Serpiginous Conjunctivitis[42]

Figure 3.

Ocular only mpox. No skin lesions with nasal episcleritis (upper left) progresses to necrotizing sclerokeratitis with a neurotrophic cornea and persistently positive MPXV detection from the ocular surface[19].