bubble_chart Overview

Gonococcal conjunctivitis, also known as gonorrheal eye or gonococcal suppurative eye disease, is an extremely severe acute purulent conjunctivitis. The characteristics of this disease include intense eyelid and conjunctival hyperemia and edema, along with copious purulent discharge. If treatment is inadequate, corneal ulcers and perforation can occur rapidly, leading to severe consequences such as blindness. After liberation, with the control of sexually transmitted diseases, this condition has become extremely rare in our country. However, in recent years, gonococcal genitourinary infections have shown a year-by-year increasing trend in China.

bubble_chart Etiology

Neonatal gonococcal conjunctivitis is mostly caused by infection from the mother's vaginal inflammatory secretions or other items contaminated with gonococcus during birth. Adult gonococcal conjunctivitis is often infected by their own or others' urethral secretions, and occasionally by hematogenous infection, known as endogenous gonococcal conjunctivitis, which usually affects both eyes, follows a benign course, and may be accompanied by elevated body temperature. It is commonly caused by Neisseria gonorrhoeae, a Gram-negative diplococcus. Familiarity with and mastery of the basic prevention and treatment principles of this disease are of significant practical importance.

bubble_chart Clinical Manifestations

Clinically, the disease is classified into neonatal and adult gonococcal conjunctivitis.

The incubation period of adult gonococcal conjunctivitis ranges from 10 hours to 2–3 days, affecting one or both eyes. The condition progresses rapidly to the infiltration stage, with severe eyelid redness, swelling, and pain; the palpebral conjunctiva is highly congested, accompanied by small hemorrhages and pseudomembrane formation; bulbar conjunctival edema occurs, and in severe cases, it protrudes beyond the palpebral fissure; preauricular lymphadenopathy and tenderness are present. In the early stage, the discharge is serous or bloody, and conjunctival scrapings reveal numerous gonococci within epithelial cells. After about 3–5 days, eyelid swelling subsides somewhat and softens, replaced by copious purulent discharge that continuously flows from the palpebral fissure, marking the purulent fistula disease stage. At this point, the discharge contains a large number of gonococci. After approximately 2–3 weeks, the purulent discharge gradually decreases but still contains gonococci and remains infectious; conjunctival edema subsides, while the palpebral conjunctiva becomes markedly thickened, with hypertrophic papillae and a rough surface, which may persist for several months. Subsequently, the inflammation resolves, leaving deep scars on the palpebral conjunctiva. Corneal complications are almost inevitable. Apart from punctate fluorescein staining of the corneal epithelium, partial or complete annular infiltration may be observed in the superficial stroma of the peripheral cornea. The infiltration is separated from the corneal limbus by a narrow clear zone, accompanied by a grade I anterior chamber reaction. In mild cases, the infiltration resolves within days, leaving a thin nebula. In severe cases, annular ulcers resembling immune-mediated marginal corneal melting or central ulcers may form, with diffuse corneal haziness, localized thinning, rapid perforation, and iris prolapse.

Neonatal gonococcal conjunctivitis is the most severe form of neonatal ophthalmia and was once a major cause of blindness in children. Cases with an incubation period of 2–5 days are mostly due to maternal birth canal infection, while those occurring more than 7 days after birth result from postnatal infection. Clinically, it manifests as severe acute conjunctivitis in both eyes. In the initial stage, the eyelids and bulbar conjunctiva show edema and congestion, with watery, serous, or bloody discharge. However, the condition progresses rapidly, transitioning to the purulent fistula disease stage within hours, with copious purulent discharge. Grade III eyelid and bulbar conjunctival edema and inflammation are present. The cornea darkens, with peripheral infiltration, ulcers, or central ulcers. Ulcer perforation, iris prolapse, intraocular inflammation, and vision loss may occur.

bubble_chart Diagnosis

The diagnosis of this disease can be confirmed based on the history of gonorrhea, the typical ocular disease progression, and bacteriological examination of secretion smears or conjunctival scrapings.

bubble_chart Treatment Measures

Gonococcal eye infections should be highly vigilant and carefully managed due to their severe and rapidly progressing nature. While general bacterial conjunctivitis is primarily treated with topical antibiotics, gonococcal infections require systemic antibiotics combined with local medication to control the condition and avoid complications.

1. Systemic Treatment: For newborns, aqueous penicillin G can be used at a dosage of 50,000 units/kg body weight per day, divided into two intravenous injections, for 7 consecutive days. For resistant cases, ceftriaxone at 25–50 mg/kg body weight per day, administered intramuscularly or intravenously, is given for 7 days. Other third-generation cephalosporins or spectinomycin may also be used. Alternatives include ampicillin, cephaloridine, erythromycin, doxycycline, kanamycin, and sulfonamide preparations. For corneal lesions, ceftriaxone is preferred, administered intravenously or as intramuscular spectinomycin. Adults may receive intramuscular procaine penicillin G aqueous solution, with probenecid taken orally 1 hour before injection and continued at reduced doses afterward. Alternatively, aqueous penicillin G can be administered intravenously for 5 consecutive days, or long-acting penicillin intramuscularly. For penicillin-resistant or allergic patients, intramuscular ceftriaxone or spectinomycin may be used.

2. Local Treatment: Thoroughly irrigate the conjunctival sac with warm saline, initially every 5–10 minutes, gradually reducing to every 15 or 30 minutes until discharge ceases. During irrigation, tilt the head toward the affected side. Initially, irrigate every minute for half an hour, then every 5 minutes for another half hour, and subsequently every half hour. After one day, reduce to hourly, and after several days, to every 2 hours, continuing for 2 weeks. Alternatively, apply 0.25% chloramphenicol, 0.1% rifampicin, or bacitracin eye drops. Apply erythromycin, gentamicin, tetracycline, or bacitracin ointment at bedtime daily. For corneal lesions, use atropine for pupil dilation. In cases of corneal ulcer perforation, perform penetrating keratoplasty or scleroplasty under antibiotic therapy.

Patients or the parents of affected children should undergo genitourinary examinations and treatment.

bubble_chart Prevention

The disease is transmitted through contact with pestilence. It is crucial for patients with gonorrhea to understand the constant risk of infecting others or their own eyes. Patients must maintain hygiene, wash hands thoroughly after using the toilet, and disinfect with a 1:10,000 mercuric chloride solution, 1% Lysol solution, or alcohol. They are strictly prohibited from swimming in public pools or bathing in public baths. If the eye becomes infected, immediate isolation and treatment are necessary. If one eye is affected, the infected eye should be covered with a transparent eye shield to protect the healthy eye, and the patient should sleep on the affected side. All dressings contaminated by the infected eye must be burned. Personal items such as washbasins and towels should be sterilized by boiling and must not be used by others. Medical personnel should wear protective goggles when examining and treating patients and must thoroughly disinfect their hands after procedures. For the prevention of neonatal gonococcal conjunctivitis, prenatal examinations are essential. Any pregnant woman with gonorrhea must receive immediate and thorough treatment. The treatment regimen includes amoxicillin or ampicillin 0.5g, 3–4 times daily, along with probenecid 0.5g, 3–4 times daily. For those allergic to penicillin, spectinomycin 2g can be administered intramuscularly. After birth, infants must strictly follow the Crede eye prophylaxis method: after cleaning the eyelids, immediately instill 1% silver nitrate solution into the conjunctival sac, or apply 1% tetracycline eye ointment or 0.5% erythromycin eye ointment.