A 25-year-old sexually active patient presents with acute mucopurulent conjunctivitis. Gram-stained conjunctival scraping shows intracellular Gram-negative diplococci. What complication is most feared if untreated?

• A Follicular conjunctivitis and pannus formation
• B Corneal perforation from hyperacute bacterial keratitis ✓
• C Chronic dacryocystitis and epiphora
• D Anterior uveitis and keratic precipitates

Explanation

Gonococcal (Neisseria gonorrhoeae) conjunctivitis presents as hyperacute purulent conjunctivitis with copious discharge, lid oedema, and chemosis. The organism is unique in its ability to penetrate intact corneal epithelium through its proteases and lipopolysaccharides, leading to rapidly progressive keratitis and corneal perforation within 24–48 hours if untreated — this is the most feared complication. Treatment requires systemic ceftriaxone (single IM/IV dose) plus frequent topical fluoroquinolone; topical alone is insufficient. Follicular conjunctivitis and pannus are features of Chlamydial (trachoma) infection. Dacryocystitis is not caused by gonococcus. Uveitis is not a feature of gonococcal conjunctivitis.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.