Clinical features:

Ø  The patient complains of redness, foreign body sensation, mucoid or mucopurulent discharge.

Ø  Itching is much less prominent.

Ø  On examination, purulent discharge, conjunctival papillae and chemosis are seen.

Ø  Clinical symptoms start within 12 to 24 hours and include severe purulent discharge, swelling of eyelids

Ø  On examination, conjunctival papillae, marked chemosis and preauricular adenopathy is observed.

If severe or recurrent, conjunctival swab for routine cultures and sensitivities and immediate Gram stain to evaluate for gonococcus.

Examination of entire cornea for peripheral ulcers (especially superiorly) should be done because of the risk for rapid perforation.

Conjunctival scrapings for immediate Gram stain and for culture and sensitivities (e.g., blood agar and chocolate agar) should be taken.

Pharmacological treatment:

Initiated if the Gram stain shows gram negative intracellular diplococci or there is a high suspicion clinically of gonococcal conjunctivitis.

1.       Inj. ceftriaxone 1 g intramuscularly in a single dose.

2.       If corneal involvement exists, or cannot be excluded because of chemosis and eyelid swelling, hospitalize the patient and treat with Inj. ceftriaxone 1 g intravenously every 12 to 24 hours.

3.       In penicillin-allergic patients, consider an oral fluoroquinolone (e.g., Tab. ciprofloxacin 500 mg, for 5 days) or a single oral dose of Tab. azithromycin 1 g.

4.       Topical ciprofloxacin ointment QID or fluoroquinolone drops every two hours (e.g., gatifloxacin, moxifloxacin, or ciprofloxacin).

5.       Saline irrigation QID until the discharge resolves.

6.       Treat for possible chlamydial co-infection (e.g., Tab. azithromycin 1 g single dose or Tab. doxycycline 100 mg BD for 7 days).

7.       Treat sexual partners with oral antibiotics for both gonorrhea and chlamydia as described previously.

Patient education:

u  The patient should be followed daily until consistent improvement is noted, and then every 2 to 3 days until the condition resolves.

u  The patient and sexual partners should be evaluated by their medical doctors for other sexually transmitted diseases.