Discussion of vaccinia virus, used for the smallpox vaccine, was previously removed from the BCSC series because of the worldwide eradication of smallpox. More recently, however, concern that smallpox (variola virus) might be used as a biological weapon has prompted the reinstitution of a smallpox vaccination program, especially for military personnel. Ocular complications from self-inoculation have been reported, including potentially severe periorbital pustules, conjunctivitis, and keratitis. Treatment includes topical trifluridine. Use of vaccinia-immune globulin (VIG) is controversial but is indicated for severe ocular disease. Concern about the use of VIG stems from limited rabbit studies that have demonstrated a possible increase in corneal scarring. Individuals who are immunosuppressed, atopic, pregnant, breastfeeding, allergic to the vaccine, or living with a high-risk household contact should not receive the vaccine because of the risk of the possibly fatal, progressive vaccinia.
Figure 9-22 Multiple molluscum contagiosum lesions on the eyelid of a patient with AIDS.
(Courtesy of James Chodosh, MD.)
Fillmore GL, Ward TP, Bower KS, et al. Ocular complications in the Department of Defense Smallpox Vaccination Program. Ophthalmology. 2004;111(11):2086–2093.
Neff JM, Lane JM, Fulginiti VA, Henderson DA. Contact vaccinia—transmission of vaccinia from smallpox vaccination. JAMA. 2002;288(15):1901–1905.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.