ACUTE PURULENT CONJUNCTIVITIS OF ADULTS

ACUTE PURULENT CONJUNCTIVITIS
Acute purulent conjunctivitis also known as acute
blenorrhea or hyperacute conjunctivitis is
characterised by a violent inflammatory response. It
occurs in two forms: (1) Adult purulent conjunctivitis
and (2) Ophthalmia neonatorum in newborn

ACUTE PURULENT CONJUNCTIVITIS
OF ADULTS
Etiology
The disease affects adults, predominantly males. Commonest causative organism is Gonococcus; but rarely it may be Staphylococcus aureus or Pneumococcus. Gonococcal infection directly spreads from genitals to eye. Presently incidence of gonococcal conjunctivitis has markedly decreased.

Clinical picture
It can be divided into three stages:
1. Stage of infiltraton. It lasts for 4-5 days and is
characterised by:

• Considerably painful and tender eyeball.
• Bright red velvety chemosed conjunctiva.
• Lids are tense and swollen.
• Discharge is watery or sanguinous.
• Pre-auricular lymph nodes are enlarged.

2. Stage of blenorrhoea. It starts at about fifth day,lasts for several days and is characterised by:

•  Frankly purulent, copious, thick dischargetrickling down the cheeks (Fig. 1).
•  Other symptoms are increased but tension inthe lids is decreased.

 3. Stage of slow healing. During this stage, pain is decreased and swelling of the lids subsides.
Conjunctiva remains red, thickened and velvety. Discharge diminishes slowly and in the end
resolution is complete.Associations. Gonococcal conjunctivitis is usually associated with urethritis and arthritis.

Complications
1. Corneal involvement is quite frequent as the gonococcus can invade the normal cornea through an intact epithelium. It may occur in the form of diffuse haze and oedema, central necrosis, corneal ulceration or even perforation.

2. Iridocyclitis may also occur, but is not as common as corneal involvement.

3. Systemic complications, though rare, include gonorrhoea arthritis, endocarditis and septicaemia.
 
Treatment
1. Systemic therapy is far more critical than the topical therapy for the infections caused by N.
gonorrhoeae and N. meningitidis. Because of the resistant strains penicillin and tetracyline are no longer adequate as first-line treatment. Any of the following regimes can be adopted :

• Norfloxacin 1.2 gm orally qid for 5 days
• Cefoxitim 1.0 gm or cefotaxime 500 mg. IV qidor ceftriaxone 1.0 gm IM qid, all for 5 days; or
• Spectinomycin 2.0 gm IM for 3 days.

All of the above regimes should then be followed by a one week course of either doxycycline 100 mg bid or erythromycin 250-500 mg orally qid.

2. Topical antibiotic therapy presently recommended includes ofloxacin, ciprofloxacin or
tobramycin eye drops or bacitracin or erythromycin eye ointment every 2 hours for the
first 2-3 days and then 5 times daily for 7 days. Because of the resistant strains, intensive therapy with penicillin drops is not reliable.

3. Irrigation of the eyes frequently with sterile saline is very therapeutic in washing away
infected debris.

4. Other general measures are similar to acute mucopurulent conjunctivitis.

5. Topical atropine 1 per cent eye drops should be instilled once or twice a day if cornea is involved.

6. Patient and the sexual partner should be referred for evaluation of other sexually transmitted diseases.