Board Review: Are we seeing eye to eye?
A 21 year old female presents to the ED with bilateral eye redness and discharge that started today. She reports her symptoms have rapidly progressed since this morning. During your exam, she frequently wipes purulent material from her eyes, which have severe chemosis and injection. Which of the below historical elements will be most helpful in making the diagnosis?
A. Past Medical History
B. Family History
C. Sexual History
D. Surgical History
Answer: C. This patient’s copious purulent eye discharge of rapid onset is most consistent with hyperacute bacterial conjunctivitis due to infection with Neisseria gonorrhoeae. This condition is acutely sight-threatening with a risk of corneal perforation. A sexual history is therefore crucial to obtain in this patient upon your initial exam. The diagnosis can ultimately be confirmed with a positive gram stain of the ocular discharge revealing gram-negative diplococci. This patient requires immediate ophthalmology involvement, antibiotics, and admission to the hospital.