Conjunctiva

Gonococcal Conjunctivitis

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Gonococcal Conjunctivitis, Gonorrhea Conjunctivitis, Gonorrheal Conjunctivitis, Hyperacute Bacterial Conjunctivitis

  • Signs
  1. Profuse purulent exudate ("waterfall of pus")
  2. Profound lid edema
  3. Chemosis
  4. Corneal Ulceration
  5. Occurs in newborns within 24-48 hours of birth
  • Management
  • Newborns
  1. General Measures
    1. Frequent saline Eye Irrigation until no discharge
    2. Treat mother and partners for Gonorrhea and Chlamydia
    3. Treat newborn also for Chlamydia Conjunctivitis
  2. Antibiotic
    1. Ceftriaxone (Rocephin) 25 to 50 mg/kg up to 250 mg IV/IM x1 dose (preferred) OR
    2. Cefotaxime (Claforan) 100 mg/kg IV/IM x1 dose
  3. Alternative if Penicillin senstive (not typically used)
    1. Penicillin G 100,000 units/kg/day IV qid for 7 days
  • Management
  • Adults
  1. Concurrently treat Chlamydia (e.g. Azithromycin 1 g orally once)
  2. Gonorrhea management
    1. Ceftriaxone 250 mg IV or IM for 1 dose AND
    2. Ciprofloxacin eye ointment 4x/day AND
    3. Saline Eye Irrigation 4x/day
  • Complications
  1. Corneal perforation (high risk)
  • References
  1. Williams (2017) Crit Dec Emerg Med 31(2): 3-12
  2. Yanoff (1999) Ophthalmology, Mosby, p. 1.7
  3. Fuloria (2002) Am Fam Physician 65(1):61-8 [PubMed]