Ocular manifestations of Clade Ib mpox in four South-Kivu health zones, Democratic Republic of the Congo

With several international outbreaks ongoing, mpox-related eye disease is increasingly detected, yet data on its prevalence remain limited. We conducted a descriptive cross-sectional study in four health zones in South-Kivu Province, Democratic Republic of the Congo, between November 1, 2024 and January 31, 2025, to describe the clinical features of mpox-related ophthalmic disease in hospitalized patients during the ongoing clade Ib outbreak. Routine ophthalmic examination was performed in laboratory-confirmed hospitalized mpox patients. The assessment included visual acuity measurement, inspection of eyelids and ocular surface with a magnifying glass, portable slit lamp biomicroscopy of the anterior segment, and ophthalmoscopy. We examined a total of 366 patients, of whom 210 (57.4%) were male. The median (IQR) age was 8 (4-16) years, 260 (71%) of the patients were younger than 15, and 168 (45.8%) were under 5. Ocular symptoms and disease were recorded in 190 (51.9%) patients. The most common ocular symptom was redness (51.9%), followed by pain (20.0%), itching (18.3%), and conjunctival discharge (16.7%). Conjunctivitis was observed in 113 (30.9%) patients. Other manifestations included blepharoconjunctivitis (7.4%), blepharitis (5.2%), and keratoconjunctivitis (3.3%). Ulcerative and non-ulcerative keratitis were present in 2.5% and 2.2% of the patients, respectively. Two (0.6%) HIV-positive patients had herpes zoster ophthalmicus. Visual impairment was recorded in 5.7% and blindness in 2.5% of the patients. Ophthalmologic manifestations were common during hospitalization in this group of patients. The early occurrence of ophthalmic manifestations requires early ophthalmic assessment for timely diagnosis and treatment to achieve better outcomes. Outbreak frontline healthcare workers should be alert of ocular symptoms such as redness, pain, sensitivity to light, and tearing in both suspected and laboratory-confirmed cases and promptly initiate an ophthalmic evaluation.