II. Causes
III. Signs
- Profuse purulent exudate ("waterfall of pus")
- Profound lid edema
- Chemosis
- Corneal Ulceration
- Occurs in newborns within 24-48 hours of birth
IV. Management: Newborns
- Ophthalmology Consultation
-
General Measures
- Frequent saline Eye Irrigation until no discharge
- Treat mother and partners for Gonorrhea and Chlamydia
- Treat newborn also for Chlamydia Conjunctivitis
-
Antibiotic
- Ceftriaxone (Rocephin) 25 to 50 mg/kg up to 500 mg IV/IM x1 dose (preferred) OR
- Cefotaxime (Claforan) 100 mg/kg IV/IM x1 dose
- Alternative if Cephalosporin allergy
- Gentamicin IM and Azithromycin orally
V. Management: Adults
- Ophthalmology Consultation
-
Gonorrhea management
- Systemic Antibiotics
- Ceftriaxone 500 mg IM/IV for 1 dose (1 gram IM/IV if weight > 150 kg, dose increased in 2020) OR
- Gentamicin 240 mg IM and Azithromycin 2 g orally for one dose OR
- Cefixime 800 mg orally once is an alternative but NOT recommended due to Antibiotic Resistance
- Topical Medications
- Saline Eye Irrigation four times daily
- Ciprofloxacin eye ointment 4x/day was previously recommended but GC resistance is high
- Systemic Antibiotics
-
Chlamydia treatment if not excluded (not indicated for Gonorrhea treatment without Chlamydia as of 2020)
- Doxycycline 100 mg twice daily for 7 days (preferred as of 2020) OR
- Azithromycin 1 g orally for 1 dose
- References
VI. Complications
- Corneal perforation (high risk)
VII. References
- Williams (2017) Crit Dec Emerg Med 31(2): 3-12
- Yanoff (1999) Ophthalmology, Mosby, p. 1.7
- Fuloria (2002) Am Fam Physician 65(1):61-8 [PubMed]