Mpox Keratitis: A Case Report and Review.

Area of Science:

• Ophthalmology
• Infectious Diseases
• Virology

Background:

• Mpox (formerly monkeypox) is a viral illness with potential ocular manifestations.
• Mpox keratitis, an infection of the cornea, is infrequently diagnosed, hindering effective patient management.
• Limited awareness among eye care professionals contributes to diagnostic challenges.

Purpose of the Study:

• To enhance knowledge of mpox keratitis among eye care professionals.
• To review the clinical presentation, diagnosis, and management of mpox keratitis.
• To report a unique case of successful corneal transplantation for mpox keratitis.

Main Methods:

• A systematic literature search identified 35 cases of mpox keratitis from 1970 to 2024.
• Analysis of case reports and abstracts to determine frequency, clinical features, and outcomes.
• Inclusion of a case study involving penetrating keratoplasty with a 20-year follow-up.

Main Results:

• Mpox keratitis occurs in 0.5%–1.0% of symptomatic mpox patients, with or without systemic disease.
• Initial misdiagnosis was common (40%); polymerase chain reaction (PCR) aids diagnosis.
• Corneal involvement varied from mild to severe; outcomes ranged from excellent vision to blindness.
• Tecovirimat showed efficacy in most cases without fulminant systemic disease.
• Successful penetrating keratoplasty was reported in one unique case.

Conclusions:

• Mpox keratitis, though rare, can lead to significant vision impairment and blindness.
• Systemic tecovirimat appears effective for mpox keratitis, but low incidence limits clinical trials.
• Topical steroids might prolong viral presence in the cornea.
• PCR is valuable for confirming corneal mpox infection.