Gonorrheal conjunctivitis

Background

• Caused by Neisseria gonorrhoeae
• Usually spread from genital-hand-eye contact in the young sexually active population
• Neonates can acquire it from the birth canal

Work-Up

1. Immediate staining for gram-negative diplococci
2. Cultures for Neisseria

Diagnosis

1. Abrupt onset
2. Copious purulent discharge (reforms quickly after wiping away)
3. Marked conjunctival injection/chemosis
4. lid swelling
5. globe tenderness through closed lids
6. preauricular lymphadenopathy
7. May or may not be associated with a urethral discharge.

Neonates

• 3-5 days postpartum (bilateral) discharge
• May be localized to other organs (arthritis, meningitis, pneumonia) or may be disseminated (sepsis)

DDx

Eye Algorithm (Main)

Treatment

1. Eye irrigation (saline)
2. Topical antibiotics
   1. same as for Bacterial Conjunctivitis
3. Systemic antibiotics for Gonorrhea
4. Urgent referral to ophtho

Disposition

1. Infant=Admit?
2. Adult=Discharge
   1. Unless evidence of complication or immunodeficiency

Complications

1. Ulceration
2. Perforation

See Also

• Conjunctivitis
• Sexually Transmitted Diseases (STD)

Source

Mahmood AR, Narang AT. Diagnosis and management of the acute red eye. Emerg Med Clin N Am. 2008;26:35-55. [{Category:ID]]