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Hyperacute Conjunctivitis with Corneal Melting d/t Neisseria go

Hyperacute Conjunctivitis with Corneal Melting d/t Neisseria go. Guy J. Ben Simon Oren Goldan Aaron Grinbaum Goldschleger Eye Institute. Case Report:. A 37 YOM, 10d prior to admission  Viral Conjunctivitis 1d prior to admission severe pain (OD). SLE (5/6/01):.

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Hyperacute Conjunctivitis with Corneal Melting d/t Neisseria go

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  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. V&F  Oflox

  5. Corneal Patch:

  6. History: • S&S 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?

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