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, PNA) or may be disseminated

Differential Diagnosis

Conjunctivitis Types

• Viral conjunctivitis
  • Epidemic keratoconjunctivitis
  • Herpes zoster ophthalmicus
  • Herpes simplex keratitis
• Bacterial conjunctivitis
  • Gonorrheal conjunctivitis
  • Chlamydia conjunctivitis
• Allergic conjunctivitis
• Caustic keratoconjunctivitis

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]]