A 35-year-old Italian man presented with unilateral ocular pain and photophobia that started 7 days before presentation. Anterior segment examination (aided by asking the patient to pull down his lower eyelid; Fig A-B) revealed multiple (> 10) umbilicated papules on the tarsal and bulbar conjunctiva, the fornix, and at the temporal limbus; the fellow eye was uninvolved. He had multiple cutaneous, genital, oropharyngeal and anal vesicular-pustular lesions, generalized lymphadenopathy, and fever (Fig C-D). Real-time polymerase chain reaction (RealStar Orthopoxvirus, Altona Diagnostics) detected presence of non-variola orthopox viral DNA on the conjunctival, oropharyngeal, cutaneous, and rectal swabs and plasma, confirming monkeypox infection. Antiviral therapy with intravenous cidofovir (5 mg/kg, single dose) was administered. The ocular papules resolved in 3 days, and no new cutaneous lesions were noted (Magnified version of Fig A-D is available online at www.aaojournal.org).
