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

Work-Up

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

Evaluation

  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

Differential Diagnosis

Conjunctivitis Types

Management

  • 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

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

  • 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

Disposition

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

Complications

  1. Ulceration
  2. 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