眼部感染可导致角膜溃疡/瘢痕和永久性视力丧失。[150]McCollum AM, Damon IK. Human monkeypox. Clin Infect Dis. 2014 Jan;58(2):260-7.
https://academic.oup.com/cid/article/58/2/260/335791
http://www.ncbi.nlm.nih.gov/pubmed/24158414?tool=bestpractice.com
[236]Mazzotta V, Mondi A, Carletti F, et al. Ocular involvement in monkeypox: description of an unusual presentation during the current outbreak. J Infect. 2022 Aug 18;85(5):573-607.
https://www.journalofinfection.com/article/S0163-4453(22)00474-1/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/35987391?tool=bestpractice.com
[237]Cash-Goldwasser S, Labuda SM, McCormick DW, et al. Ocular monkeypox: United States, July - September 2022. MMWR Morb Mortal Wkly Rep. 2022 Oct 21;71(42):1343-7.
https://www.cdc.gov/mmwr/volumes/71/wr/mm7142e1.htm
http://www.ncbi.nlm.nih.gov/pubmed/36264836?tool=bestpractice.com
眼部并发症可由自体接种导致。在当前正在发生的疫情暴发中,大约不到 1% 的患者存在眼部受累。[238]Centers for Disease Control and Prevention. Interim clinical considerations for management of ocular monkeypox virus infection. October 2022 [internet publication].
https://www.cdc.gov/poxvirus/monkeypox/clinicians/ocular-infection.html
患者可表现为结膜炎、睑缘炎、角膜炎、结膜下结节或眶周蜂窝织炎。[230]Mailhe M, Beaumont AL, Thy M, et al. Clinical characteristics of ambulatory and hospitalised patients with monkeypox virus infection: an observational cohort study. Clin Microbiol Infect. 2022 Aug 23 [Epub ahead of print].
https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(22)00428-1/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/36028090?tool=bestpractice.com
[239]Benatti SV, Venturelli S, Comi N, et al. Ophthalmic manifestation of monkeypox infection. Lancet Infect Dis. 2022 Sep;22(9):1397.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00504-7/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/35914539?tool=bestpractice.com
[240]Meduri E, Malclès A, Kecik M. Conjunctivitis with monkeypox virus positive conjunctival swabs. Ophthalmology. 2022 Oct;129(10):1095.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9534064
http://www.ncbi.nlm.nih.gov/pubmed/35973854?tool=bestpractice.com
[241]Scandale P, Raccagni AR, Nozza S. Unilateral blepharoconjunctivitis due to monkeypox virus infection. Ophthalmology. 2022 Nov;129(11):1274.
https://www.aaojournal.org/article/S0161-6420(22)00632-7/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/36041955?tool=bestpractice.com
[242]Ly-Yang F, Miranda-Sánchez A, Burgos-Blasco B, et al. Conjunctivitis in an individual with monkeypox. JAMA Ophthalmol. 2022 Oct 1;140(10):1022-4.
https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2796171
http://www.ncbi.nlm.nih.gov/pubmed/36069834?tool=bestpractice.com
[243]Foos W, Wroblewski K, Ittoop S. Subconjunctival nodule in a patient with acute monkeypox. JAMA Ophthalmol. 2022 Sep 7:e223742.
https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2796172
http://www.ncbi.nlm.nih.gov/pubmed/36069930?tool=bestpractice.com
[244]Milligan AL, Koay SY, Dunning J. Monkeypox as an emerging infectious disease: the ophthalmic implications. Br J Ophthalmol. 2022 Oct 10 [Epub ahead of print].
http://www.ncbi.nlm.nih.gov/pubmed/36216412?tool=bestpractice.com
建议所有眼部受累的患者进行眼科咨询。裂隙灯检查和散瞳眼底检查可能有助于确定是前段还是后段结构受累。[238]Centers for Disease Control and Prevention. Interim clinical considerations for management of ocular monkeypox virus infection. October 2022 [internet publication].
https://www.cdc.gov/poxvirus/monkeypox/clinicians/ocular-infection.html
推荐使用维生素 A 补剂。眼部润滑剂和盐水浸泡的眼垫可能有帮助。对于合并感染,可能需使用眼用抗生素/抗病毒药物。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication].
https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
建议使用外用的抗病毒药物。外用抗病毒药物曲氟尿苷(三氟胸苷)已被用于治疗眼部牛痘,并且可被用于加速症状的缓解和预防瘢痕形成引起的长期损害。[245]Hu G, Wang MJ, Miller MJ, et al. Ocular vaccinia following exposure to a smallpox vaccinee. Am J Ophthalmol. 2004 Mar;137(3):554-6.
http://www.ncbi.nlm.nih.gov/pubmed/15013881?tool=bestpractice.com
建议在咨询眼科医生的情况下使用曲氟尿苷治疗猴痘角膜炎。对于某些出现近眼部病变的患者,也可以预防性地使用以防止自体接种;但是,必须考虑到长期使用会有角膜上皮毒性的风险。应避免使用外用皮质类固醇,因其可能导致角膜损伤或病毒持续存在。[238]Centers for Disease Control and Prevention. Interim clinical considerations for management of ocular monkeypox virus infection. October 2022 [internet publication].
https://www.cdc.gov/poxvirus/monkeypox/clinicians/ocular-infection.html
应考虑将 tecovirimat 用于所有重症(包括有眼部症状)患者。请参阅“治疗流程”。
在咨询传染病专家的情况下,可根据具体情况考虑使用牛痘免疫球蛋白。然而,建议谨慎用于活动性角膜炎患者,因为在一项动物模型研究中观察到角膜瘢痕形成增加。[238]Centers for Disease Control and Prevention. Interim clinical considerations for management of ocular monkeypox virus infection. October 2022 [internet publication].
https://www.cdc.gov/poxvirus/monkeypox/clinicians/ocular-infection.html
请参阅“新兴治疗”。
角膜炎