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Conjunctivitis ("pink eye") is the most common mpox complication of the eyes, followed by impaired vision, keratitis, and eye lesions, findings that highlight the need for early recognition, routine eye exams, and effective treatment—particularly in mpox-endemic regions such as Africa and in patients with weakened immune systems, a meta-analysis of 25 studies concludes.

For the analysis, published yesterday in the Journal of Infectious Diseases, researchers in India performed a systematic review of studies on mpox-related ophthalmic complications published up to September 8, 2024.

"Recent outbreaks of monkeypox (Mpox) have raised concerns about its complications, including ophthalmic manifestations such as conjunctivitis, keratitis, and potential vision impairment," the authors wrote. "The lack of comprehensive data on these ocular complications hinders the development of effective clinical guidelines."

Prompt recognition, treatment required

The pooled prevalence of conjunctivitis in mpox patients was 8.9%, followed by impaired vision (4.3%), keratitis (3.4%), and eye lesions (3.4%). Other mpox-related eye complications had a pooled prevalence of 12.4%. The notable rate of keratitis is clinically relevant because, without prompt recognition and treatment, it can lead to poor outcomes such as corneal ulceration and vision loss, the researchers said. 

Routine ocular examinations and timely referrals to ophthalmologists are essential for enhancing patient outcomes.

"In Mpox, direct viral invasion of ocular tissues or immune-mediated damage might account for these manifestations," the authors wrote, adding that complication rates may depend on mpox infection severity, patient demographics, and access to healthcare.

"Routine ocular examinations and timely referrals to ophthalmologists are essential for enhancing patient outcomes," they wrote. "Moreover, preventive measures such as vaccination and prompt antiviral treatments are crucial for reducing disease severity and preventing complications like keratitis and potential vision loss."

"The insights from this study are vital for guiding clinical practice and public health strategies, underscoring the importance of further research to explore risk factors, intervention strategies, and to fill existing gaps in our understanding of Mpox-related ocular complications," they added.

The team noted significant bias and heterogeneity among studies, especially for conjunctivitis and other ocular manifestations, which they said suggests variability in presentation and documentation.