SGD

WRITTEN OUTPUT
Case 1

3G Group 4

Pangilinan, Danielle Mae M.

Pituk, Ciara Janelle N.
Punsalan, Patrick Joseph G.
Roco, Charmaigne Rae S.
Roy, Subham
Simbahan, Bernadette P.
Sumabat, Ciaralyn C.
Valenzuela, Tricia A.
Villanueva, Myka Bernice D.
Case 1
A 20 year old female seeks consult at the ER complaining of purulent discharge, OU.

3 days PTC, patient complained of eye redness and watery discharge, OU upon
waking up. Later that day, she developed periorbital swelling and slight blurring of
vision. Patient applied a topical medication borrowed from her brother who also had
eye redness and tearing a week ago.

The following day, only slight improvement was noted so she applied breast milk on
both eyes. Upon an elderly neighbor’s advice, she also applied a drop of urine (her
own), OU. No consults were made.

1 day PTC, there was noted eye pain and photophobia, OS, profuse, purulent eye
discharge, OU and progressive blurring of vision, OS>OD. Persistence of the
aforementioned symptoms prompted consult.

● (-) diabetes, hypertension or allergies

● (-) contact lens use, previous trauma or surgery
● (+) smoker and alcoholic beverage drinker

(OD - right eye, OS - left eye)

BCVA:
● OD 20/30
● OS HM with PLPj
IOP:
● OD soft
● OS not fully assessed
Pupils:
● OD 3mm
● OS not fully assessed
EOMS: full and equal

Discussion
● Signs and Symptoms
○ Purulent discharge on both eyes
○ Eye redness
○ Periorbital swelling
○ Eye pain and photophobia on left eye
○ Progressive blurring of vision, predominantly on the left eye
● PE and Diagnostic or Laboratory Findings
● BCVA:
○ OD 20/30
○ OS HM with PLPj
● IOP:
○ OD soft
○ OS not fully assessed
● Pupils:
○ OD 3mm
○ OS not fully assessed
● EOMS:
○ full and equal
● Etiology
○ Gonococcal conjunctivitis is conjunctivitis caused by Neisseria
gonorrhoeae (gonorrhea), a sexually transmitted disease that also
may spread to the eye by contact with genital secretions from a
person who has a genital gonorrheal infection.

● Treatment Goals or Objectives

○ Conjunctivitis secondary to sexually transmitted disease such as
chlamydia and gonorrhea requires systemic treatment
○ Gonorrhea and chlamydia often times occur together so the treatment
must cover both bacteria
○ Identify, screen and treat partner
○ Remove eye mucopurulent discharge
○ Improve vision, function and pain
○ Stop the infection
○ For the Cornea transplant (left eye):
■ restore vision and function
■ reduce pain
■ improve the appearance of damaged/diseased cornea

● Pharmacologic Intervention
○ Single dose of 1 g IM Ceftriaxone
○ Single dose of 1 g Oral Azithromycin
○ Corneal transplant on the left eye since there is a presence of corneal
melting

● Adverse Effects
○ Ceftriaxone
■ Diarrhoea, nausea, vomiting; neutropenia, eosinophilia,
anaemia, rash, pruritus, fever, chills, increased serum
 concentrations of AST, ALT, BUN; local reactions (e.g. pain,
induration, ecchymosis, tenderness at inj site). Rarely,
pancreatitis, hypoprothrombinaemia.
■ Potentially Fatal: Anaphylaxis, Clostridium difficile-associated
diarrhoea and colitis, haemolytic anaemia.
○ Azithromycin
■ Significant: Myasthenia gravis.
■ Ear and labyrinth disorders: Deafness.
■ Eye disorders: Pruritus, burning, stinging of the eye or ocular
discomfort, sticky eye sensation, foreign body sensation
(ophthalmic).
■ Gastrointestinal disorders: Diarrhoea, vomiting, abdominal pain,
nausea, flatulence, dyspepsia, dysgeusia.
■ General disorders and admin site conditions: Injection site pain,
fatigue.
■ Investigations: Decreased lymphocyte count and blood
bicarbonate; increased eosinophil count, basophils, monocytes
and neutrophils.
■ Metabolism and nutrition disorders: Anorexia.
■ Musculoskeletal and connective tissue disorders: Arthralgia.
■ Nervous system disorders: Headache, dizziness, paraesthesia.
■ Skin and subcutaneous tissue disorders: Pruritus, rash.
■ Potentially Fatal: Rarely, serious hypersensitivity reactions (e.g.
anaphylaxis, angioedema, Stevens-Johnson syndrome, toxic
epidermal necrolysis, acute generalised exanthematous
pustulosis drug reaction with eosinophilia and systemic
symptoms), fulminant hepatitis leading to liver failure,
prolonged cardiac repolarisation and QT interval, cardiac
arrhythmia, torsades de pointes, Clostridium difficile associated
diarrhea (CDAD).

● Surgical Intervention

In cases of severe Gonococcal conjunctivitis where in the integrity of the cornea has
been ulcerated or in if the bacteria has melted the cornea, surgery can be required.

According to a study by Kayarzynga Et al (2017) the primary goal in repairing the

corneal perforation is to achieve a watertight globe with structural integrity
,however corneal perforation does not always require immediate surgical treatment.
The primary goal in repairing the corneal perforation is to achieve a watertight
globe with structural integrity in order to prevent severe complications such as
globe tissue prolapse.