Timely treatment needed to avoid poor outcomes in ocular monkeypox
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Patients with ocular monkeypox experienced delays in treatment, prolonged illness, hospitalization and, in one case, significant vision impairment, according to a CDC report.
“Ocular monkeypox is rare but can be a sight-threatening condition,” study author Shama Cash-Goldwasser, MD, told Healio/OSN. “Anyone with monkeypox can develop ocular monkeypox if the virus gets into the eye, which can occur through autoinoculation of the eyes — or if a patient touches a lesion and then touches their eye.”
The report outlines five cases of ocular monkeypox reported from July to September 2022 that demonstrate the range of symptoms and varying clinical manifestations of the disease.
Four of the patients were hospitalized, and one experienced marked vision impairment. Additionally, two of the patients had HIV-associated immunocompromise and experienced delays between clinical presentation and initiation of monkeypox-directed treatment, according to the report.
“As of the publication of our report, one of these patients is still experiencing significant vision impairment, and his vision prognosis is not known,” Cash-Goldwasser said.
For treatment, all five patients received tecovirimat, and four received topical trifluridine. Interim clinical guidance from the CDC suggests the use of both tecovirimat and trifluridine for treatment, according to Cash-Goldwasser.
National surveillance data found that 5% of patients with monkeypox in the U.S. report ocular symptoms, although the frequency of ocular monkeypox is still unknown.
In addition to general hand hygiene, the CDC recommends patients with monkeypox avoid touching their eyes and using contact lenses. The CDC also suggests that clinicians should consider initiating prompt antiviral therapy for patients who are at risk for severe manifestations of disease, including ocular monkeypox, according to the report.
“We lack understanding of whether people with HIV are at higher risk for ocular monkeypox than people without HIV,” Cash-Goldwasser said. “We do not know enough about long-term outcomes of ocular monkeypox, regardless of HIV status. So, during this outbreak, it would be great to see longer-term studies on clinical outcomes in patients with ocular monkeypox.”
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