Ophthalmic Features and Implications of Poxviruses: Lessons from Clinical and Basic Research

Abstract

Amidst the ongoing monkeypox outbreak, global awareness has been directed towards the prevention of viral transmission and case management, with the World Health Organization declaring the outbreak a public health emergency of international concern. Monkeypox virus is one of several species in the Orthopoxvirus genus, with other species of the genus including the variola, cowpox, mousepox, camelpox, raccoonpox, skunkpox, and volepox viruses. Although the nomenclature of these species is based on the animal host from which they were originally isolated, transmission from animals to humans has been reported with several species. The progression of disease, following an incubation period, typically consists of a prodromal phase with systemic flu-like symptoms. Various organ systems may be affected in addition to the formation of pathognomonic skin lesions. As monkeypox poses a continued public health concern, the ophthalmic sequelae of monkeypox virus, especially those leading to vision loss, warrant consideration as well. This review provides a comprehensive summary of the ophthalmic implications of poxviruses in clinical and laboratory settings reported in the literature, as well as areas of unmet need and future research.

Monkeypox Virus Immune Evasion and Eye Manifestation: Beyond Eyelid Implications

“…Hence, it is plausible that both direct viral cytopathic effects and the host's immunological response contribute equally to the clinical and histological stage-like presentation of MPXV [137]. Conjunctival phlyctenules, stemming from a type IV hypersensitivity reaction (cell-mediated), are occasionally reported (Figure 3) [138,139].…”

The Host–Pathogen Interplay: A Tale of Two Stories within the Cornea and Posterior Segment

“…While not specifically evaluated in a large meta-analysis, adenoviruses and herpesviruses are the most routinely encountered viruses within the eye ( Table 2 ) [ 8 ]. However, there can be geographic variation in the most common ocular pathogens and rare ocular presentations from unlikely organisms [ 9 , 10 , 11 , 12 , 13 ]. This is most clearly seen with the geographic distribution of the three clades of Toxoplasmosis gondii worldwide and the very rare occurrence of Trypanosome cruzii -associated retinitis [ 9 , 14 , 15 , 16 ].…”