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Canalicular obstructions after monkeypox infection.

Óscar Felguera-García1,2, Marina Dotti-Boada1,2, Sara Labay-Tejado1,2

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Monkeypox virus (MPX) infection can cause persistent lacrimal obstruction, specifically canalicular damage, even after ocular symptoms resolve. Surgical interventions for these MPX-related tear drainage disorders proved unsuccessful in restoring normal tear flow.

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Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Virology

Background:

  • The 2022 monkeypox virus (MPX) outbreak included ocular manifestations like conjunctivitis and periocular vesicles.
  • Lacrimal drainage system complications following ocular MPX have not been previously documented.

Purpose of the Study:

  • To report and describe two cases of lacrimal obstruction following ocular infection with monkeypox virus.
  • To highlight the association between MPX-induced periocular vesicles and subsequent canalicular damage.

Main Methods:

  • Case report of two patients with a history of ocular MPX infection.
  • Review of clinical photographs to identify vesicles near the lacrimal drainage pathway.
  • Surgical intervention including canaliculodacryorhinostomy and exploratory punctoplasty.

Main Results:

  • Two distinct cases of lacrimal obstruction (distal and proximal canalicular) were identified months after initial MPX ocular infection.
  • Photographic evidence confirmed vesicles in areas corresponding to the sites of canalicular damage.
  • Both surgical procedures failed to reestablish normal tear drainage.

Conclusions:

  • Ocular monkeypox virus infection can lead to persistent lacrimal drainage disorders.
  • This study presents the first documented association between viral vesicular lesions from MPX and canalicular obstructions.
  • Further research is needed to understand the pathophysiology and explore effective treatments for MPX-related lacrimal complications.