Bacterial - Hyperacute

- Usually unilateral with a fulminant onset (< 24 hours)

- Copious purulent discharge, conjunctival hyperemia, redness, and irritation. Preauricular lymphadenopathy commonly seen.

- Corneal perforation can occur in up to 10% of cases. Refer to an ophthalmologist promptly.

- Obtain Gram stain and culture of conjunctival scrapings.

- Consider adjunctive topical antibiotic therapy (bacitracin-polymyxin or erythromycin).

 
Usual Pathogens

N. gonorrhoeae
N. meningitidis

 

Empiric Therapy Dose Duration
Ceftriaxone 2g IV/IM 1 dose
+    
[Azithromycin 1g PO 1 dose
or    
Doxycycline] 100mg PO bid 7 days

Severe cephalosporin allergy

Empiric Therapy Dose Duration
Ciprofloxacin 500mg PO 1 dose
+    
[Azithromycin 1g PO 1 dose
or    
Doxycycline] 100mg PO bid 7 days