Mucopurulent ocular discharge

Specialty: Ophthalmology.

• persistent blemishes
• pus in the eyes
• purulent conjunctival exudate

Why it occurs

• Acute bacterial conjunctivitis (commonly due to Staphylococcus aureus, Streptococcus pneumoniae, or Haemophilus influenzae)
• Acute dacryocystitis due to obstruction and bacterial infection of the lacrimal sac
• Chronic bacterial canaliculitis
• Hyperacute conjunctivitis due to Neisseria gonorrhoeae or Chlamydia trachomatis (in newborns or sexually active adults)
• Bacterial infectious keratitis with deep stromal involvement

Initial workup

Sample collection of conjunctival secretion for urgent smear with Gram or Giemsa stain and microbiological culture with antibiogram (especially in neonates, immunosuppressed patients or cases with unfavorable evolution); Slit lamp examination with fluorescein stain to assess epithelial integrity and rule out concomitant corneal ulcers; Exploration of the lacrimal points and the lacrimal sac.

Standard management

• Moxifloxacin — 0.5% eye drops, 1 drop every 4 hours during the first days; Broad-spectrum fourth-generation fluoroquinolone, indicated in severe bacterial keratoconjunctivitis
• Tobramycin — 0.3% eye drops, 1 drop every 4 hours in common bacterial conjunctivitis
• Ceftriaxone (1 g intramuscularly or intravenously in a single dose for adults, or adapted regimen in newborns if origin is confirmed by Neisseria gonorrhoeae, associated with profuse conjunctival washing with sterile saline solution).