Vaccinia keratitis

Infection of the cornea due to implantation of vaccinia virus from a smallpox vaccination. People with pre-existing eye disease (particularly inflammatory diseases of the lids, conjunctiva and cornea) are particularly prone to implantation of the vaccinia virus from contact with contaminated hands. Caretakers who bath or otherwise handle children with vaccinations are the most likely to experience such transfer. A week to 10 days after transfer the clinical signs of infection appear in the cornea. The infection can cause abrasion, ulceration and subsequent clouding of the cornea which impairs vision. Without treatment, there may be considerable scarring as the lesion heals with significant impairment of vision. Topical antiviral agents are the treatment of choice. Current information suggests that a combination of an antiviral nucleoside and interferon topically speeds healing. Agents such as vidarabine, trifluridine or acyclovir have been used. Vaccinia Immune Globulin (VIG) is contraindicated for use in vaccinial keratitis. If VIG is administered, an antigen-antibody reaction is accentuated in the cornea and may result in significantly more cloudiness than in the normal healing process.