Hyperacute Conjunctivitis with Corneal Melting d/t Neisseria go

1
Hyperacute Conjunctivitis with Corneal Melting
d/t Neisseria go

• Guy J. Ben Simon
• Oren Goldan
• Aaron Grinbaum
• Goldschleger Eye Institute

2
Case Report

• A 37 YOM, 10d prior to admission ? Viral
  Conjunctivitis
• 1d prior to admission severe pain (OD)

3
SLE (5/6/01)

• OD HM, AT seemed N, Swollen eyelids,
  chemosis, corneal descemet folds, Iris
  intact US Normal
• OS 6/6, Normal
• CT periorbital tissue swelling

4
SLE 6/6/01

• VA LP, Low AT, Iris Prolapse
• On 6/6/01 ? OD Corneal Patch (GA)
• Local Tx. VF ? Oflox

5
Corneal Patch
6
History

• SS of urethritis w discharge ? N. GoIM
  Ceftriaxone (later ? IV Ceftriaxone)
• Culture (conjunctiva) ? G- Cocci

7
SLE 11/06/01

• Swollen eyelids, Chemosis
• VA 6/120 PH 6/60
• Minimal Corneal Erosion, Corneal Patch, Normal AT
• AC D, F/C
• F - Normal

8
Continue follow-up (RE)

• Tarsoraphy
• Corneal graft abscess
• Strep. Viridans
• Local ABx (Oflox)
• 7/01 AMT d/t persistent erosion
• Last FU (8/01) VA HM, Normal AT, Corneal
  opacity, minimal erosion

9
Persistent erosion
10
AMT
11
N. Gonorrhoea

• Primary cause of STD in USA
• Urethritis, anal canal, cervix, throat
• Hyper-acute conjunctivitis
• Infant URTI, conjunctivitis
• Women
• Peritonitis, pelvic abscess, perihepatitis

12
N. Gonorrhoea

• Bacteremia
• Fever, rash
• Arthralgia, infectious arthritis
• Petechia, papules, necrotic patches
• Rare myocarditis, toxic hepatitis

13
N. Gonorrhoea

• Ophthalmic manifestations
• Young sexually active adults
• Hyper-acute conjunctivitis
• Endophthalmitis
• Rare iridocyclitis (with arthritis)
• N. meningitidis ?
• meningococemia, meningitis, endogenous
  endophthalmitis

14
Hyperacute Conjunctivitis
15
Hyperacute Conjunctivitis

• Neisseria gonorrhoea
• Neisseria meningitidis
• Others

16
Hyperacute Conjunctivitis

• Swollen eyelid
• Hyperemia and chemosis
• Purulent discharge
• If untreated
• Corneal ulceration
• Corneal perforation
• Endophthalmitis

17
Hyperacute Conjunctivits

• Positive history of STD
• Intracellular (PMN) Gram - diplococci
• Culture Thayer Martin / chocolate
• Bacteria can attach epithelial cells and invade
  host
• Can avoid human defense mechanism of phagocytosis
  

18
Hyperacute Conjunctivits

• Treatment with IM Ceftriaxone
• Followed by IV Penicillin
• Local ABx eyedrops
• Additional ABx against chlamydia trachomatis
• Doxyline
• Azithromycine

19
Destructive epidemic Neisseria gonorrhea
keratoconjunctivitis in African adults

• BMJ 1985 (Jul) 525-8

20
Patients and Methods

• Age 18-60Y
• 4 presented with bilateral corneal melting and
  perforation with iris prolapse

21
N.gonorrhea KC with corneal destruction (patient
1)
22
N.gonorrhea corneal perforation and
endophthalmitis (patient 2)
23
Results

• History Physical examination revealed evidence
  of acute N.go venereal infection in all 16 pts
• Tx. IM procaine PCN for 9 days
• Eyedrops of crystalline PCN, atropine
• Tetracycline ointment

24
Results

• Of 32 normally sighted eyes prior to infxn only
  14 retained VA of 6/6
• 5 eyes were enucleated
• 7 VA of 6/120 or worse
• Possible connection to rains, hemorrhagic
  conjunctivitis

25
What America and Afghanistan are doing?