Ophthalmic Manifestations of the Mpox Virus: A Systematic Review and Meta-Analysis

Recent outbreaks of monkeypox (Mpox) have raised concerns about its complications, including ophthalmic manifestations such as conjunctivitis, keratitis, and potential vision impairment. The lack of comprehensive data on these ocular complications hinders the development of effective clinical guidelines. This review aim to synthesize existing evidence on the prevalence and characteristics of Mpox-related ocular complications. A systematic literature search was conducted across PubMed, Embase, Web of Science, and Scopus, covering studies up to September 8, 2024. Studies focusing on conjunctivitis, keratitis, eye lesions, visual impairment, and other ophthalmic outcomes in Mpox cases were included. Meta-analyses were performed using a random-effects model to estimate pooled prevalence rates, with heterogeneity assessed using the I² statistic. Sensitivity analyses and publication bias assessments were also conducted. A total of 25 studies were included, with 22 contributing to the meta-analysis. The pooled prevalence of conjunctivitis in Mpox cases was 8.9% (95% CI: 4.4%-17.1%), keratitis 3.4% (95% CI: 1.4%-7.7%), eye lesions 3.4% (95% CI: 1.4%-7.7%), and visual impairment 4.3% (95% CI: 0.8%-20.6%). Other ocular manifestations had a pooled prevalence of 12.4% (95% CI: 0.6%-76.9%). Significant heterogeneity was observed, particularly for conjunctivitis and other ocular manifestations, suggesting variability in presentation. Conjunctivitis is the most common ophthalmic complication of Mpox, followed by notable rates for keratitis, eye lesions, and visual impairment. These findings emphasize the need for early recognition, routine ocular exams, and effective management of Mpox-related eye complications. Further high-quality research is necessary to better understand and address these ocular complications.