What are the complications, prevention and treatment of ocular monkeypox?

In a report from the Centers for Disease Control and Prevention (CDC), Weekly reports of morbidity and mortality Researchers have reported five monkeypox cases with ocular complications. They discussed the treatment and prevention of ocular monkeypox.

Background

The 2022 monkeypox epidemic has resulted in more than 26,000 cases in the United States. Skin lesions in most of these cases resolved with no or minimal treatment, but lesions near vulnerable areas such as the eyes caused complications. Monkeypox virus enters the eye, commonly by self-inoculation, and can cause conjunctivitis, keratitis, and even blindness.

Ocular monkeypox is defined as the development of eye disease in a patient with suspected or confirmed monkeypox. This cannot be explained by conditions other than monkeypox. This report describes the symptoms, treatment, and outcomes of her five patients who developed ocular monkeypox between July 2022 and her September. Two were infected with the human immunodeficiency virus (HIV) and were immunocompromised.

Ophthalmic monkeypox case

Patient A was an HIV-positive male aged 20 to 29 who had not received antiretroviral therapy (ART) and had a rash on his arms, chest, and buttocks suggestive of monkeypox infection. He developed itching, pain, discharge, swelling, and photosensitivity in his left eye after 10 days.When his ocular symptoms worsened, trifluridine eye drops were administered to the left eye and tecovirimato was administered intravenously.

Despite improvement and discharge, the patient was readmitted due to decreased visual acuity in the left eye and increased facial lesions. Eye examination revealed keratitis, conjunctivitis, and conjunctival ulceration. Conjunctival lesion swabs were positive for orthopoxvirus. Intravenous tecovarimat and trifluridine infusion were resumed. The patient remained hospitalized at the time of reporting, and his prognosis was unknown.

Patient B is another HIV-positive male aged 30 to 39 years and not on ART therapy. He had a rash on his legs, chest, face, perianal area, and one lesion on his nose near his right eye. A swab test was positive for orthopoxvirus, so he was started on ART and tecovirimato, which he was prescribed for 2 weeks. His facial lesions worsened and his nasal bridge lesions expanded to his right eye, resulting in conjunctivitis, nodular and conjunctival lesions, and corneal ulceration of his right eye. He was given intravenous tecovirimato and trifluridine eye drops and discharged after 10 days with improvement.

Patients C and D were previously healthy men between the ages of 30 and 39 years. Patient C presented with perianal lesions and rectal pain. He developed lesions on his abdomen, penis, and wrists. He experienced pain in his right eye, discharge from the eye, redness, and subsequent bilateral conjunctivitis. He was treated with tecovirimato until all symptoms resolved.

Patient D developed a groin rash, swelling, redness, and pain in the right eye. Ocular symptoms worsened with periorbital swelling, multiple eyelid lesions, conjunctivitis, lid margin ulceration, and conjunctival lesions. No changes in visual acuity were observed. Swab samples from conjunctival lesions were positive for orthopoxvirus. Patients were treated with antibiotics, trifluridine eye drops, and oral tecovirimat.

The fifth patient (patient E) was a previously healthy 30- to 39-year-old woman with a vaginal pustular lesion extending to her buttocks, back, forehead, chin, and left eyelid. Ocular examination detected bulbar conjunctival lesions, left ocular conjunctivitis, and subconjunctival nodules. She was treated with trifluridine eye drops and oral tecovirimat.

preventive measures

CDC recommends that people with monkeypox observe good hand hygiene and avoid touching their eyes and using contact lenses. Health care workers recommend that you be aware of ocular monkeypox symptoms, as the disease can lead to blindness. should and public health authorities should be notified of the case.

Conclusion

In summary, the current CDC report discusses 5 cases of ocular monkeypox, 2 of which were HIV-positive and not on ART. One of his HIV-positive patients experienced vision loss and his prognosis remains unknown. Most cases have been treated with trifluridine eye drops and oral tecovirimat with significant improvement with adherence to the treatment regimen.

CDC recommends strict hygiene protocols to avoid self-inoculation. This includes washing your hands and avoiding contact lenses and eye contact. They advise health care workers to immediately investigate suspected cases of ocular monkeypox and to initiate empirical treatment in the meantime.