Severe Monkeypox Infection of the Eye and Periocular Region

Background: Monkeypox is an emerging zoonotic infection with potentially severe ocular and periocular consequences, particularly in immunocompromised patients. Case Presentation: Two cases of monkeypox presenting in patients with AIDS are described. In the first case confluent lesions resulted in orbital compartment syndrome and total eyelid necrosis. In the second case eyelid involvement was accompanied by corneal melt and perforation. Despite aggressive treatment both patients developed permanent loss of vision and, in one case, death. Conclusions: Many cases of ocular or periocular monkeypox are mild and self-limiting. In immunocompromised patients more severe disease may manifest and requires systemic as well as local ophthalmologic treatment.