A 36-year-old female individual with a confirmed diagnosis of Monkeypox, by the Centers for Disease Control and Prevention, presented to the hospital for an ophthalmic evaluation of left-eye redness and discomfort corresponding to a bulbar conjuntival lesion.The results of the ophthalmic examination were grossly unremarkable except for sectoral hyperemia of a fluorescein-staining subconjunctival nodule (Figure , A) on the left eye and an adjacent left upper eyelid umbilicated nodule with central crusting (Figure , B). The hyperemic lesion did not blanch with administration of topical phenylephrine. The patient was treated with oral nonsteroidal anti-inflammatory medications and reevaluated the following day, which was significant for interval improvement (Figure , B). The immunologic workup was grossly negative to date. Although little is known of the ocular manifestations of monkeypox, studies have shown that ocular surface pathology includes conjunctivitis, blepharitis, keratitis, corneal ulceration, and eyelid scarring. Of note, one patient developed corneal opacification requiring corneal transplant in one case. [1][2][3][4] Our case study proposes that hyperemic, subconjunctival nodules are a clinical finding in patients with active monkeypox that can be treated with oral nonsteroidal anti-inflammatory medications.

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Siponimod is a sphingosine-1-phosphate receptor modulator used as disease-modifying therapy for relapsing-remitting multiple sclerosis similar to Fingolimod which has been known to cause dose dependent fingolimod associated macular oedema (FAME). We report a case of delayed onset bilateral cystoid macular oedema in a patient with stable proliferative diabetic retinopathy who developed cystoid macular oedema in the setting of siponimod (Mayzent; Novartis Pharmaceuticals; Cambridge, Massachusetts, USA) use. As with FAME, cystoid macular oedema resolved in the patient’s eyes with drug cessation and adjunctive topical anti-inflammatory therapy. We highlight unique fluorescein angiographic findings within this class of drugs as well as the clinical challenge posed by comorbid diabetic and inflammatory ophthalmic pathology.