Gonorrheal conjunctivitis

(Redirected from 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

Clinical features

  • Abrupt onset
  • Copious purulent discharge (reforms quickly after wiping away)
  • Marked conjunctival injection/chemosis
  • Lid swelling
  • Globe tenderness through closed lids
  • Preauricular lymphadenopathy
  • May or may not be associated with features of urethritis

Neonates

Differential Diagnosis

Conjunctivitis Types

Evaluation

  • Gram staining for gram-negative diplococci
  • Cultures for Neisseria

Management

Bacterial Conjunctivitis

  • Counsel patient/family on importance of hand hygiene/avoiding touching face to prevent spread!

These options do not cover gonococcal or chlamydial infections

  • Polymyxin B/Trimethoprim (Polytrim) 2 drops every 6 hours for 7 days OR
  • Erythromycin applied to the conjunctiva q6hrs for 7 days OR
  • Levofloxacin 0.5% ophthalmic solution 1-2 drops every 2 hours for 2 days THEN every 6 hours for 5 days OR
  • Moxifloxacin 0.5% ophthalmic 1-2 drops every 2 hours for 2 days THEN every 6 hours for 5 days OR
  • Gatifloxacin 0.5% ophthalmic solution 1-2 drops every 2 hours for 2 days THEN 1 drop every 6 hours for 5 days OR
  • Azithromycin 1% ophthalmic solution 1 drop BID for 2 days THEN 1 drop daily for 5 days

NB: levofloxacin is preferred for contact lens wearers for coverage of pseudomonas. Advise not to wear contacts for duration of treatment

Chlamydial

  • Doxycycline 100mg PO BID for 7 days OR
  • Azithromycin 1g (20mg/kg) PO one time dose
  • Newborn Treatment: Azithromycin 20mg/kg PO once daily x 3 days
    • Disease manifests 5 days post-birth to 2 weeks (late onset)

Gonococcal

  • Due to increasing resistance, CDC recommends dual therapy with Ceftriaxone and Azithromycin (even if patient is negative for Chlamydia).
  • Ceftriaxone 250mg IM one dose PLUS
  • Azithromycin 1g PO one dose
  • Newborn Treatment:
    • Prophylaxis: Erythromycin ophthalmic 0.5% x1
    • Disease manifests 1st 5 days post delivery (early onset)
    • Treatment Ceftriaxone 25-50mg IV or IM, max 125mg

Disposition

  • Infant=Admit?
  • Adult=Discharge
    • Unless evidence of complication or immunodeficiency

Complications

  • Ulceration
  • Perforation

See Also

References

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

Authors:

Ross Donaldson