Ocular complications of smallpox vaccination.
OBJECTIVE
To describe the ocular complications of smallpox vaccination and to discuss potential therapeutic options.


METHODS
Review of pertinent medical literature and recent treatment recommendations of the Centers for Disease Control and Prevention.


RESULTS
After immunization against smallpox, vaccinia infection of the eyelid, conjunctiva, or ocular surface can result from accidental autoinoculation from a vaccination site before scab formation or from contact with a recently vaccinated individual. While uncommon, corneal involvement can lead to stromal opacification and scarring. Clinical findings of ocular and periocular vaccinia must be differentiated from those produced by other pathogens such as molluscum contagiosum, herpes simplex, varicella zoster, and acanthamoeba infections. Clinical diagnosis can be confirmed by electron microscopy to identify the presence of orthopoxvirus, as well as by virologic culture, polymerase chain reaction, and/or restriction endonuclease analysis of viral isolates.


CONCLUSIONS
While the majority of ocular complications of smallpox vaccination in immunocompetent patients are self-limiting, selective cases may require treatment with trifluridine drops, topical corticosteroids and vaccinia immune globulin (VIG). Vaccinia virus does not appear to be sensitive to acyclovir. Specific treatment recommendations are outlined for the spectrum of ocular manifestations.
Pepose
Jay S
JS
Pepose Vision Institute, Chesterfield, Missouri 63017, USA.
Margolis
Todd P
TP
LaRussa
Phillip
P
Pavan-Langston
Deborah
D
D002487:Centers for Disease Control and Prevention, U.S.; D003229:Conjunctival Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D015828:Eye Infections, Viral / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D005141:Eyelid Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D005938:Glucocorticoids / Q000627:therapeutic use; D049673:History, 20th Century; D006801:Humans; D007167:Immunotherapy; D016133:Polymerase Chain Reaction; D017410:Practice Guidelines as Topic; D012899:Smallpox / Q000266:history / Q000517:prevention & control; D012900:Smallpox Vaccine / Q000009:adverse effects*; D014271:Trifluridine / Q000627:therapeutic use; D014481:United States; D014611:Vaccination / Q000009:adverse effects*; D014615:Vaccinia / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D014776:Virus Cultivation
D005938:Glucocorticoids; D012900:Smallpox Vaccine; D014271:Trifluridine