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  • Ophthalmic Burden of Mpox

    By Jean Shaw
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, January 2023

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    In a primer on the 2022 outbreak of Mpox, Kaufman et al. compiled clin­ically relevant information regarding Mpox and its ophthalmic manifesta­tions. They report that Mpox-related ophthalmic disease (MPXROD) may be associated with severe ocular and visual morbidity, and they note that ophthal­mologists may play an important role in the diagnosis and management of the viral disease.

    Highlights of the primer include the following:

    • Virology. The Mpox virus (MPXV) is a member of the genus Orthopoxvi­rus, which includes the variola, vaccin­ia, and cowpox viruses. The incubation period of MPXV is typically seven to 14 days but may be up to 21 days.
    • Clinical presentation. MPXV infec­tion typically begins with a prodromal fever, followed two to three days later by skin and oropharyngeal/mucosal eruptions. Lymphadenopathy may be noted. The number of skin lesions var­ies widely, from fewer than 25 to more than 500. Other complications include bronchopneumonia, gastroenteritis, and encephalitis.
    • Ophthalmic manifestations. Ocular findings may include external and ocular surface lesions. Eyelid margin lesions occurring in association with conjunctivitis have been reported. Cor­neal disease in the setting of MPXV can include ulcerative keratitis, immune stromal keratitis, and neurotrophic keratitis. Persistent MPXROD may be present as late as six weeks from the onset of MPXV and can be severe.
    • Ophthalmic treatment. There is no FDA-approved topical ophthalmic antiviral agent specific for MPXV infection, although the CDC recom­mends considering topical trifluridine use in cases of MPXROD. Generous topical lubrication remains an import­ant component of supportive ocular therapy, and topical antibiotics for corneal ulceration and epithelial defects may be important to prevent bacterial superinfection.
    • Corneal transplantation concerns. There are no reported cases of Mpox transmission by corneal transplant to date. However, patients with active Mpox conjunctivitis can shed virus, and the Eye Bank Association of Amer­ica has developed recommendations regarding corneal transplantations.

    The original article can be found here.