Eyeworld

49 EW FEATURE May 2018 • Navigating the red eye both," Dr. de Luise said. "Ceftriax- one treats the gonococcus and the meningococcus, but does not treat chlamydia. Patients with chlamydia need to be given a second antibiotic, which is azithromycin, 1 g orally. That treats the chlamydia, and the ceftriaxone treats the Neisseria agent." All sexual partners should be identified, contacted, and treated as well. He noted that the cornea is in- volved in almost half of the cases of hyperacute bacterial conjunctivitis. "About 40% of the time, there is an ulceration or a perforation, which is a sight-threatening and life-threat- ening emergency. These patients need to be admitted to the hospital to an infectious disease service. These patients require intravenous ceftriaxone because the intramuscu- lar route doesn't work quick enough. They should be treated with intra- venous ceftriaxone, 1 g IV every 12 hours for 3 days. Ceftriaxone is a cousin of penicillin, so if a patient has a penicillin allergy, we can use ofloxacin, 400 mg orally twice a day for 5–7 days, or spectinomycin 2 g intramuscularly for at least 3 days," Dr. de Luise said. He added that all patients with hyperacute bacterial conjunctivitis need to be treated for gonococcus and for concomitant chlamydial infection, just in case. "It takes a few days to prove this by culture, so we should give the patient 1 g orally. It's a simple thing to do, very few people have reactions to it, and it kills the chlamydial piece of the puzzle. The chlamydia is not causing the hyperacute pus. That's being caused by the Neisseria. Chlamydia is one of those things that happens to be there a lot in patients with gonorrhea, therefore you want to treat both," Dr. de Luise said. Concurrent chlamydial con- junctivitis is commonly seen and should be managed with one of the following: • Azithromycin 1000 mg single dose • Doxycycline 100 mg bid for 7 days • Tetracycline 250 mg qid for 7 days • Erythromycin 500 mg qid for 7 days Ophthalmia neonatorum This is conjunctivitis in neonates. The two major organisms responsi- ble for ophthalmia neonatorum are Neisseria gonorrhoeae and Chlamydia trachomatis. Gonococcal ophthalmia neonatorum is caused by Neisseria gonorrhoeae. "Neonates also may have systemic manifestations, in- cluding rhinitis, stomatitis, arthritis, meningitis, anorectal infection, and septicemia," Dr. de Luise said. Treatment is topical erythro- mycin and intramuscular or in- travenous ceftriaxone (25 mg/kg to 50 mg/kg, up to a maximum of 125 mg), according to Dr. de Luise. Prevention of conjunctivitis in neonates is through the use of 1% silver nitrate or 0.5% erythromycin ointment. "There are limits to what you can give babies, but they can be given ceftriaxone, just like adults. While this is very uncommon in children, the doctor has to have his or her antenna up because you don't want to miss it. This is a life-threatening disease in adults and children," he said. EW Editors' note: Dr. Mah has financial interests with Novartis (Basel, Switzer- land), Bausch + Lomb (Bridgewater, New Jersey), and Allergan (Dublin, Ireland). Dr. de Luise has no financial interests related to his comments. Contact information de Luise: vdeluisemd@gmail.com Mah: Mah.Francis@scrippshealth.org I-Ring ® Pupil Expander BVI, BVI Logo and all other trademarks (unless noted otherwise) are property of Beaver-Visitec International ("BVI") © 2018 BVI Beaver-Visitec International, Inc. US: 1-866-906-8080 EU: 44 (0) 1865 601256 bvimedical.com "As a cataract and retina surgeon, I have found the I-Ring to consistently produce round, intact postoperative pupil margins." — Harvey Uy, MD A safe and effective solution for intraoperative small pupil expansion • Gentle on iris and other intraocular tissue • Iris quickly returns to natural shape post-surgery • Easy insertion and removal Call your local sales rep or customer service at 1-866-906-8080 Visit iring.net for clinical information For information on all BVI products, visit bvimedical.com

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