Table 1.

Ocular manifestations, management and outcome of monkeypox during the 2022 outbreak

Type of investigation	Country	Age and sex	Ocular complications	Ocular PCR test for Monkeypox DNA	Systemic treatments	Ocular treatments	Outcome	References
Case report	Cameroon	14-year-old male	Bilateral eye redness, conjunctival injections and no discharge	NR	Oral cloxacillin 500 mg	Tetracycline 1% eye ointment	Symptoms resolved after 7 days with no complication	[57]
Case report	US	36-year-old female	Left eye redness, discomfort and subconjunctival and left upper eyelid umbilicated nodules	NR	Oral nonsteroidal anti-inflammatory (NSAIDs)	Topical phenylephrine	Significant improvement in the follow-up period	[58]
Case report	Spain	42-year-old male	Left eye pain, photophobia and lacrimation Left eyelid margin lesions with discharge and conjunctival whitish infiltrative lesion and thickness No corneal lesions or intraocular inflammation	Positive on conjunctival swabs	Systemic tecovirimat 600 mg and acyclovir 1 g	Ocular drops, including chlorhexidine 0.2%, povidone-iodine 1%, ganciclovir 0.15% and moxifloxacin	Conjunctival pseudomembranes developed in the second week of treatment. Lesion excision and fluorometholone were initiated, and lesions were resolved after 4 weeks	[63]
Case report	Italy	35-year-old male	Right eye pain and photophobia Over 10 umbilicated papules in the tarsal and bulbar conjunctiva, temporal limbus and fornix	Positive in conjunctival swabs	IV cidofovir 5 mg/kg	NR	Ocular lesions resolved after 3 days of treatment	[59]
Observational cohort study	France	10 patients with ocular symptoms	Two had ocular impairments requiring hospitalization. One had minor palpebral lesions, and the other had blepharoconjunctivitis with severe keratitis	NR	IV cidofovir 5 mg/kg and oral valaciclovir	Ocular dexamethasone, ganciclovir, tobramycin	The case with keratitis did not show full resolution of symptoms during the hospital stay	[25]
Case report	Italy	26-year-old male	Multiple papular lesions in the right eyelid with progressive conjunctival and peri-orbital involvement deteriorating into more lesions in the upper and lower eyelids and the fornix, periorbital edema and conjunctival hyperemia	Positive in both eyelid and conjunctival swabs	Intravenous cidofovir (5 mg/kg weekly) and oral probenecid	Topical steroid therapy anti-inflammatory and vitamin A-based eye drops	Asynchronous recession of the lesions and a total disappearance approximately 2 months after the onset of the symptoms	[56]
Case report	Switzerland	39-year-old male	Right eye itchiness and redness Conjunctival follicular reaction Small white vesicles present on the nasal bulbar conjunctiva	Positive in conjunctival swabs	NR	NR	NR	[64]
Case report	Italy	39-year-old male	Left eye blepharoconjunctivitis with a small lesion on the left lower eyelid	Positive in both eyelid and conjunctival swabs	NR	Polymixin B, neomycin and dexamethasone eyedrops	No ocular lesions remained 3 weeks after the onset of the symptoms (redness remained)	[60]
Case series	16 countries	3 patients with ocular symptoms	Conjunctival lesions	NR	NR	NR	NR	[24]
Case series	US	20–29 year old male	Left eye pain, redness, itching, photosensitivity, discharge, foreign body sensation and vision problem Left eye conjunctivitis with conjunctival lesions and keratitis	Positive in conjunctival swabs	Oral and Intravenous tecovirimat	Topical trifluridine	Over 22 days of hospitalization that was ongoing at the time of the study with considerable vision impairment	[66]
Case series	US	30–39 year old male	Right eye pain, itching, redness and photosensitivity Right eye conjunctivitis with multiple small conjunctival nodules and corneal ulcer	NR	Oral and intravenous tecovirimat	Topical trifluridine	After 10 days of hospitalization, the patient was discharged with the improvement of eye lesions and no vision changes	[66]
Case series	US	30–39-year-old male	Initially, right eye redness, pain and discharge Extending to bilateral conjunctivitis	NR	Oral tecovirimat	NR	After 1 month of treatment, ocular symptoms were resolved with no vision changes	[66]
Case series	US	30–39-year-old male	Right eye pain, redness and periorbital swelling Right eye conjunctivitis, conjunctival and eyelid lesions, and preseptal cellulitis	Positive in both eyelid and conjunctival swabs	Oral tecovirimat and Intravenous antibiotics for preseptal cellulitis	Topical trifluridine and antibacterial drops	After 5 days of hospitalization, the patient was discharged with clinical improvement and no vision impairments	[66]
Case series	US	30–39-year-old female	Left eye pain and redness Left eye conjunctivitis, a lesion on the bulbar conjunctiva and a subconjunctival nodule	NR	Oral tecovirimat	Topical trifluridine	The patient was discharged with no ocular symptoms and vision change 3 days after hospitalization	[66]
Case report	US	30-year-old male	Ulcers on right lower palpebral conjunctiva, right caruncle and a papule on right upper eyelid	Ocular lesions were not swabbed	Oral tecovirimat	Artificial tears and erythromycin	After 6 days of treatment, the patient was discharged from the hospital with improved conjunctival lesions. The eyelid margin became red, and eye irritation resolved without vision impairments	[67]
Case report	Australia	38-year-old male	Right eye conjunctival injections, foreign body sensation, epiphora and intermittent blurring of vision Right eye blepharoconjunctivitis with mild edema of lower and upper eyelids, conjunctival hyperemia and medial cantus lesion	Positive in both medial cantus and conjunctival swabs	Oral tecovirimat	Lubricating drops, ointment (paraffin + retinol palmitate) and topical chloramphenicol drops	The patient's symptoms were completely resolved after 1 week of therapy	[68]