Ocular mpox in Southern Nigeria during the 2022 and 2024 outbreaks: a report of two cases

There are significant knowledge gaps regarding the burden and clinical progression of ocular manifestations of mpox in Nigeria and worldwide. Here, we report two laboratory-confirmed mpox cases among young male adults with distinct ocular mpox presentations at two tertiary hospitals in southern Nigeria during the 2022 and 2024 global outbreaks. The first patient, a 28-year-old man, presented at the Alex Ekwueme Federal University Teaching Hospital in Abakaliki with a vesiculopustular rash on his nasal bridge and right lower eyelid, along with redness, pain, and itching. He subsequently developed corneal ulcers and vision problems after discharge, necessitating an ophthalmology review. The second case involved a 44-year-old man with advanced HIV, who presented with widespread vesiculo-pustular eruptions, including characteristic periorbital and orbital rashes. He presented with widespread vesiculo-pustular skin eruptions, including characteristic rashes around the periorbital and orbital areas. His condition deteriorated rapidly, leading to his death after seven days of hospitalisation. Consistent with guidance from the Nigeria Center for Disease Control and Prevention, lesional skin swabs from both patients were sent to the National Reference Laboratory in Abuja for quantitative polymerase chain reaction (qPCR), which tested positive for the monkeypox virus. Supportive care included antibiotics, antivirals, intravenous fluids, nutritional support, and skin care, as no specific mpox treatments were available at that time. Ocular disease has emerged as an increasingly common yet underreported manifestation of mpox in Nigeria since the 2022 global outbreak. Ophthalmologists should be part of the multidisciplinary team of specialists caring for mpox patients with ocular manifestations. Ongoing surveillance and research are vital to better understand eye-related complications and to improve the prevention and treatment of ocular symptoms, thereby preventing significant vision loss.