Abstract
Purpose :
While monkeypox is well known for its dermatological and respiratory complications, ocular manifestations can also present. Here we describe two patients with corneal manifestations of monkeypox infection.
Methods :
Two patients, one 28 and one 36, presented with severe unilateral eye pain, photophobia, corneal ulceration, and decreased vision. Data including history, ocular examination, corneal scrapings for cultures and swabs for PCR, and follow-up were taken.
Results :
The first patient, 28, with past medical history of HIV and syphilis presented with significant photophobia and HM vision, and a severely injected left eye with ulceration and thinning at the inferior juxta-limbal region concerning for peripheral ulcerative keratitis. There was also stromal keratitis with significant haze and edema above the area of ulceration involving 2/3 of cornea (Fig. 1). Corneal swab for PCR returned positive for monkeypox and the patient was placed on systemic antiviral medication (tecovirimat) as well as topical antiviral (trifluridine) for 1 month. Follow-up exam showed a healed ulcer and decreased photophobia and improved vision of counting finger at 2 feet. The second patient, 36, with past medical history of newly diagnosed HIV, latent tuberculosis, and syphilis presented with significant eye pain and photophobia and corneal infiltrate inferiorly with a large overlying epithelial defect (Fig. 2). Vision in the affected eye was 20/200. Corneal scraping and cultures for bacterial and fungal infection came back negative. Corneal swab for PCR came back positive for monkeypox. He was started on oral tecovirimat as well as trifluridine drops for 1 month. As of his most recent follow up, best corrected vision in the affected eye improved to 20/70. His corneal epithelial defect has healed with subepithelial and stromal corneal opacities.
Conclusions :
Monkeypox is an infectious pathogen with the opportunity to involve ocular structures and can cause different forms of keratitis. The resulting keratitis may lead to ulceration, thinning, corneal scar and visual loss. Monkeypox infection can be considered as a differential in cases of corneal ulceration of unclear etiology.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.