At the frontline of emergency eye care

A patient suffered 360-degree corneal melt after contracting gonococcal keratoconjunctivitis

02 Oct 2017 by Selina Powell

A patient who presented with a discharging left eye was found to have gonococcal keratoconjunctivitis, delegates to an emergency eye care conference heard.

Specialist trainee ophthalmologist, Dr Chinedu Igwe, shared the case during a short presentation competition at the British Emergency Eye Care Society annual meeting in Birmingham (29 September).

The patient told doctors that his eye had been discharging for the past seven days. Dr Igwe revealed that swabs of the patient's eye tested positive for neisseria gonorrhoeae.

Dr Igwe explained that this condition could be contracted by direct or indirect inoculation of infected urine or genital secretions in the eye.

The patient was suffering from 360-degree peripheral corneal melt, she added.

"The clock was ticking. We knew we had a very short time to save his eye," Dr Igwe emphasised.

The patient's condition improved after treatment, she added.

Using case studies from patients with a variety of conditions from syphilis to cirrhosis, consultant medical ophthalmologist, Dr Will Innes, highlighted that eye health professionals have a key role to play in looking at the broader health of a patient during his presentation Causes of death in the emergency eye service.

"We need to spot the sick patient behind the slit lamp," he shared.

He emphasised that clinicians should observe general health by taking note of whether the patient is alert or drowsy, pink or pale, warm or cold and whether their pulse is fast or slow.

Dr Innes shared the case of a 44-year-old patient with tuberculosis who presented with anterior chamber granuloma. The patient's visual issues resolved after steroid treatment.

Dr Innes also shared an example of retinopathy connected with cirrhosis in a 32-year-old and a 52-year-old man with syphilis who presented with scintillating scotoma.

After treatment with procaine penicillin, the patient made a full recovery.

"These types of cases do really well if we treat them early," Dr Innes shared.

Swift, clear communication with colleagues outside of ophthalmology can be life-saving, Dr Innes added.

"In all of these cases the eye doctor is in the position to recognise the disease but also, having spotted it, they need to get in touch with the relevant colleague," he concluded. 

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