Patients who waited up to two months for the Ministry of Health to deliver tecovirimat experienced vision loss; frame reversal is not yet guaranteed
The delay in accessing tecovirimthe only drug approved by the National Health Surveillance Agency (Anvis) for the treatment of monkeypox, can make the disease evolve in an unbridled way and with atypical ocular manifestation. This occurred in at least ten monkeypox (or mpoxide) patients in São Paulo, treated by Luciana Finamor, an ophthalmologist who specializes in eye infections.
In two of them, waiting 60 days for the drug resulted in blindness in one eye, a condition that the existing literature cannot yet determine whether it is reversible.
The latest shipment of tecovirimat that arrived in Brazil brought the care of two patients to São Paulo, treated in the public network, who were accompanied by the report. In both monkeypox evolved without specific viral treatments for two months and in a serious way, transmitting the wounds from the skin to the corneas and compromising the vision of both up to blindness.
Cases of ocular manifestation of monkeypox are still rare, but they have already been documented. In an October report, the US Center for Disease Control and Prevention (CDC) warned that the disease can cause “serious complications” in the eyes, with five cases recorded in the country between August and September. all treated with tecovirimat.
The signs appear after the skin sores have already partially or completely healed, about 15 to 40 days after the onset of the most common symptoms, such as fever, pain and fatigue. They start as an irritation of the eye, which can become reddish, watery, with a strong sensitivity to light and a gritty sensation behind the eyelid, which can progress to vision loss.
“Although they are few, these cases make us anxious because we have tried all the possibilities and we have not been able to cure them. The patient simply does not improve,” says Dr. Luciana Finamor, an eye infection specialist at the Federal University of San Paul (University). “Therefore, it’s important to have access to antivirals, so we can better fight the disease.”
One of the hypotheses for this condition is the self-inoculation caused by the patients themselves, who transmit the virus to the eye by scratching the wounds and then touching their face. Another possibility is that, as an immune-privileged organ, the eye allows the virus to remain “hidden” until it causes a chronic inflammatory condition that is impossible to fight with natural antibodies alone.
“Today I only see numbers,” says Paulo (fictitious name), a 37-year-old restaurant manager Luciana cares for, whose eye damage from monkeypox began to show 27 days after the disease first showed signs. The initial symptoms were fever, pain and sores in the hand, mouth and arm on 7 September.
Almost a week after experiencing the first irritations in his eyes, Paulo went to an ophthalmologist, where he was advised to use a combination of eye drops which had no effect. He went to a second specialist, who this time started him on treatment for shingles. It was already mid-October and 20 days after the onset of eye symptoms when he finally got a correct diagnosis.
“I could see little, but the irritation was gigantic,” she says. “Photophobia existed (at the beginning of the disease), but not as big as today. I could drive to appointments, today I don’t drive anymore. I have lost the reflection on my left side due to the eye; I can’t even see the rear view mirror. I can’t go out in the sun either, I start crying.”
History repeated itself with Felipe (fictitious name), a 42-year-old doctor who also took 22 days to be sure that the eye irritation was a consequence of monkeypox, which he was diagnosed on Aug. 30. “I had a very serious deterioration. There were days when I couldn’t see anything. My eye got very red, I couldn’t look at the light. I had to stay in a dark room because even the light from the cell phone and the television made me it caused pain.”
Without access to tecovirimat, Felipe started using a combination of medicines to relieve pain and irritation in his eyes, with eye drops and lubricating gels, ophthalmic ointments for sleeping, a second eye drop dripped every hour and a third, an antibiotic, applied every six hours. Even though he works in the medical field, he says she “lived for his eyes” and had to take time off from work, but he’s only told his direct bosses why.
“Most people don’t know it’s because of monkeypox. It still has a lot of stigma and that can complicate me,” she confesses. “But I was very scared because I knew I wasn’t being treated the way I should and I thought I was going to go blind, lose my eye or need a corneal transplant.”
Paulo and Felipe spoke to the reporter in November, three days before the second shipment of tecovirimat arrived in Brazil and when they still didn’t even know if it would arrive or take effect. Today, one month after the start of the treatments, the future is still uncertain and the total regression of the eye damage is not guaranteed. Although they have evolved well, both have scars on the cornea and it is possible that they will need a transplant to fully recover their vision.
“We cannot give up on this because the disease has a natural course in the body. But, based on what we see in the world literature, at least in the ophthalmological framework, tecovirimat helps”, comments Luciana. “We haven’t seen serious eye cases like here in Brazil yet, because in other countries they are using the antiviral very early, right at the onset of symptoms.”
questioned by Stageor Ministry of Health informed that the criteria for access to tecovirimat are a positive laboratory result with a visible lesion or a hospitalized patient with the severe form of the infection. For this second group, the presence of the following clinical manifestations is taken into account: encephalitis, pneumonia, skin lesions with more than 250 eruptions throughout the body, extensive lesion of the oral mucosa and/or extensive lesion of the rectal mucosa.
According to the file, so far, 28 treatments have been delivered in Brazil thanks to donations from World Health Organization 🇧🇷WHO) and the manufacturer. Of these, 16 arrived in November, including 10 targeted directly to eligible patients.
In a statement, the São Paulo State Health Secretariat (SES) reports that it has received 11 requests for treatment with tecovirimat during the current monkeypox outbreak. The file also claims to follow the treatment protocol and the clinical definition established by the Ministry of Health for cases of ocular manifestation of the disease.
Take a look at some symptoms of monkeypox (monkeypox) eye manifestation:
- redness in the eye
- Ache
- Itching or irritation
- Feeling “gritty” behind the eyelid
- Photophobia (high sensitivity to light)
- tearing
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Source: Terra
Ben Stock is a lifestyle journalist and author at Gossipify. He writes about topics such as health, wellness, travel, food and home decor. He provides practical advice and inspiration to improve well-being, keeps readers up to date with latest lifestyle news and trends, known for his engaging writing style, in-depth analysis and unique perspectives.
