Monkeypox Related Keratouveitis: A Case Report

The purpose of this case report is to present the clinical course and management of a 34-year-old male with Monkeypox-related keratitis in the right eye. Aiming to highlight therapeutic interventions and initial outcomes of a patient with Monkeypox-related keratouveitis.

This case was presented and managed at Dhahran Eye Specialist Hospital (DESH). The patient presented to the emergency room (ER) with severe sub-acute ocular symptoms, including swelling, pain, photophobia, and decreased vision. Prior to his presentation, the patient was diagnosed with Monkeypox with skin manifestations in another hospital.

A 34-year-old male with a history of Monkeypox 2 months prior to presenting to the ER with a complaint of right eye swelling, pain, redness, tearing, photophobia, and decrease of VA. The patient had visited other centers with limited improvement. His VA was CF2ft, and IOP of 28, the SLE showed moderate conjunctival injection, corneal haze, inferior crescent shaped stromal infiltrate with CED of 2* 4 mm, the anterior chamber had +2 mixed cells with flare, no clear view to the iris or fundus. B-scan revealed a flat retina, no choroidal thickening, and quiet posterior segment. Our impression was Herpetic versus Monkeypox-related Keratouveitis. Oral Valacyclovir, Topical Cyclopentolate, Moxifloxacin, and Dorzolamide\Timolol were started, with close F/U.

During subsequent visits, the patient had reported improvement, however, the clinical picture remained the same initially. 1 month later, CED was healed and the vision improved to 20\400 and 20\200. Cyclopentolate was switched to Cyclosporine at one point, and the patient was stabilized by the 3-month mark. Awaiting full stabilization to consider PKP.

This case emphasises the importance of detailed history taking in ocular settings, leading to early recognition and management. 

It also highlights the multimodal treatment methods of combining systemic and topical medications. 

Close follow-up role is demonstrated in this case, as it allowed adaptive therapy and management of complications. 

Consideration of surgical intervention for better visual potential.