Gonorrheal conjunctivitis


  • 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


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


  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.


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

Differential Diagnosis

Conjunctivitis Types


  • Treatment for bacterial organisms is targeted toward S. aureus, S. pneumoniae, H. influenzae, Pseudomonas, N. gonorrhea, C. trachomatis
  • Contact lens wearers should be given coverage for Pseudomonas with one of the fluoroquinolone drops

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 fir 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


  • 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)


  • Dual treatment for Chlamydia is recommended with azithromycin
  • Ceftriaxone 1g 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
  • Eye irrigation (saline)
  • Systemic antibiotics for Gonorrhea
  • Urgent referral to ophtho


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


  1. Ulceration
  2. Perforation

See Also


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