INTRODUCTION

 The conjunctiva is a translucent mucous membrane which lines the posterior surface of the
eyelids and anterior aspect of eyeball.
 The inflammation of the conjunctiva is known as “Conjunctivitis”.
 There are two main classes of conjunctivitis: Infectious (Viral, Bacteria), Non-infectious
(Allergic, Chemicals, Foreign body, Trauma, Neoplasm).
Bacteria conjunctivitis

 It is highly contagious but rarely serious.

 The most common causes of bacteria
conjunctivitis include : Staphylococcus aureus,
Staphylococcus epidermis, Streptococcus
pneumonia, Haemophilus Influenza.

 Less commonly the infection can be as a

result of following STIs: Chlamydia and
Gonorrhea.

GONOCCOCAL CONJUNCTIVITIS

Gonococcal conjunctivitis is an infection that is transmitted by contact of the eyes

with infected genital secretions from a person with genital gonorrhea infection.

Epidemiology

Worldwide, the incidence of gonococcal infection in the newborn is less than 1%.
Developed countries tend to have lower incidences due to the availability of screening
and treatment options. Rates in developing countries are likely to be significantly
higher considering the prevalence of gonococcal infection in pregnancy is
approximately 5% in some parts of Africa.
In the non-neonatal populations, GC is rare.

Etiology

Causative Organism:

GC is caused by a bacteria (the gram-negative diplococcus Neisseria gonorrhoeae). It

usually affects two groups of people:

 New borns and sexually active adults

Mode of transmission

 Neonatal infection (gonococcal ophthalmia neonatorum) occurs during passage of the infact
through the birth canal.

 For all other individuals, this type of transmission may be due to two reasons:

 Autoinoculation is when an infection in one area of the body (genitals)

spreads to other areas of the same body (eyes)
 Inoculation is spreading the infection to a sexual partner.

Pathophysiology
A gonococcal infection has an incubation period of 3 to 19 days.
In neonates; it manifests within 1-7days after birth.

 N. gonorrhoeae can attach to and penetrate the epithelial cells of mucosal surfaces
such as the conjunctiva. Once inside, the bacteria can proliferate and induce pro-
inflammatory mechanisms. 

RISK FACTORS

Different risk factors exist for gonococcal conjunctivitis, including:

 Exposure to infected urinary or genital secretions

 Contact lens wear
 Being immunodeficient or immunosuppressed
 Prior ocular disease
 History of STIs 
 Young age 
 Alcohol misuse or recreational drug use 

SIGNS AND SYMPTOMS

Symptoms

 Painful and tender eyeball

 Photophobia
 Swollen eyelids
 Mucopurulent discharge
 Tearing
 Irritation

Signs

 Conjunctival injection
 Chemosis
 Tenderness of the globe
 Lymphadenopathy(Pre-auricular lymph nodes are enlarged).

Differential diagnosis

 Allergic conjunctivitis
 Viral conjunctivitis
 Epidermic keratoconjunctivitis
 Blepharitis
 Orbital cellulitis

Differentiating features of common types of conjunctivitis

Table below:

Investigations

 A detailed case history 

 Visual acuity measurements to
determine whether vision has been
affected.
 Evaluation of the conjunctiva and
external eye tissue.
 Swab collection
Complications
Corneal involvement: corneal ulcerations
and corneal scarring.
Untreated cases can result in vision loss.
Treatment:
Systemic antibiotics, topical antibiotics,
NSAIDs, saline lavage
 Systemic therapy:
Injections: ceftriaxone(1.0 gm IM qid) Cefoxitim( 1.0 gm IV qid) for 5
days.

Oral dose: Azithromycin(1.0gm oral qid)

 Topical antibiotic therapy: ofloxacin, ciprofloxacin or tobramycin eye drops can
be recommended. Eythromycin eye ointment every 2 hours for the first 2-3 days
and then 5 times daily for 7 days.

 Non steroidal anti inflammatory drugs: Tab diclofenac(50mg bd), gutt ivyflur 8
hourly for 7 days.

 Saline lavage: Irrigation of the eyes frequently with sterile saline is very
therapeutic in washing away infected debris.

 Patient should be referred for evaluation of other sexually transmitted diseases.

NEONATAL PROPHYLAXIS

Use of either 1 percent tetracycline ointment or 0.5 percent erythromycin ointment or

1 percent silver nitrate solution (Crede's method) into the eyes of the babies
immediately after birth.

Single injection of ceftriaxone 50 mg/kg IM or IV (not to exceed 125 mg) should be

given to infants born to mothers with untreated gonococcal infection.

Curative treatment for neonates:

Neonates with gonococcal ophthalmia should be treated for 7 days with one

of the following regimes:

Saline lavage hourly till the discharge is eliminated.

Ceftriaxone 75-100 mg/kg/day IV or IM, QID.

Cefotaxime 100-150 mg/kg/day IV or IM, 12

hourly.

Ciprofloxacin 10-20 mg/kg/day or Norfloxacin

10 mg/kg/day.

Prevention of GC:
 Good hygiene

 Washing the eyelid and applying warm, wet compresses 

 Frequent use of hand sanitizers

 No swimming in pools

 Avoidance of contact between the infected and healthy eye

 Transmission can be reduced by using latex barriers(e.g condoms or dental dams)
during sex and by limiting sexual partners.

Prognosis:

The prognosis for a complete recovery

without sequelae is excellent for
gonococcal conjunctivitis. But when left
untreated it can lead to corneal
peforation,corneal ulceration and even
blindness.
Conclusion:
Gonococcocal conjunctivitis is a rare
condition, It should not be dismissed
because untreated cases can result in
severe complications such as vision loss.
In older age groups,gonococcal
conjunctivitis is more associated with
sexually transmitted infections but can
also present without evidence of
concomitant genital infection.
Recommendations:
 Preventive practices should be
encouraged.
 Prompt treatment should be practiced
to reduce complications from disease.
 Further evaluation of other STIs should
be encouraged.
 Follow up visit.
References

McElnea E, Stapleton P, Khan S, et al. Challenges in the

management of N. gonorrhoeakeratitis. Int Ophthalmol. 2015;35(1):135–
140. doi:10.1007/s10792-014-0032-8

Bodurtha Smith AJ, Holzman SB, Manesh RS, Perl TM. Gonococcal
conjunctivitis: a case report of an unusual mode of transmission. J
Pediatr Adolesc Gynecol. 2017;30(4):501–502.
doi:10.1016/j.jpag.2016.11.003

McAnena L, Knowles SJ, Curry A, Cassidy L. Prevalence of gonococcal conjunctivitis in

adults and neonates. Eye (Lond). 2015;29(7):875–880. doi:10.1038/eye.2015.57