Ocular Infection By Monkeypox Virus: A Case Report.

To demonstrate that ocular involvement by Monkeypox virus, when corneal involvement is present, can cause severe ocular lesions that can condition the patient's visual prognosis. However, early diagnosis, with appropriate medical and systemic treatment, can help the patient's visual acuity to progress favourably and avoid chronic complications.

A 37-year-old man was diagnosed with monkeypox conjunctivitis with symptoms of eyelid oedema, hyperemia and secretions in the left eye, associated with pain and preauricular adenopathy. During follow-up, VA dropped to 0.6 and he presented inflammatory corneal ulcers, symblepharon and fibrin in the fornix. He required hospital admission for systemic treatment. Finally, the evolution was favourable with a VA of 1.0 in AO and a faint leukoma with stromal vessels and symblepharon as sequelae.

Diagnosis was confirmed by PCR analysis of conjunctival exudate performed on up to 2 occasions and sent for study. The case was followed up for 6 months with continuous monitoring by measuring visual acuity and taking photographs of the anterior segment and examination by biomicroscopy. The patient required hospital admission in addition to topical and systemic treatment for infectious conjunctivitis with ulcerative keratitis caused by monkeypox virus.

The patient was treated with 5% Povidone Iodine, topical Ofloxacin (Exocin®), as well as topical Ganciclovir 0.15% (Virgan®), topical Ozonised Oil 0.5% (Ozonest®) and systemic treatment with oral Tecovirimat 600mg (Tpoxx®). After starting systemic treatment with oral Tecovirimat (Tpoxx®) and topical Ganciclovir 0.15% (Virgan®), a significant improvement was observed, to which the use of 20% Autologous Serum eye drops for the treatment of residual corneal lesions also contributed. Finally, the patient was treated with Fluorometholone eye drops, showing a favourable evolution.

Ocular involvement by Monkeypox virus is often mild and self-limiting. It usually manifests non-specific symptoms and signs such as preseptal cellulitis, conjunctival hyperemia, photosensitivity and secretions, without significantly affecting vision. In more severe cases, such as those with treatment-resistant corneal damage, multidisciplinary management can be of great help in administering systemic therapy, as well as monitoring with photographs of the anterior segment to determine the best treatment for each case. The most frequent complications in the event of poor evolution will be the formation of leukomas with the consequent permanent loss of vision.