Ocular Infections

An increasing number of ocular infections caused by gonorrhoea or syphilis are being diagnosed in Ireland, the 2014 Irish College of Ophthalmologists annual conference in Limerick heard.

Dr Susan Knowles, consultant microbiologist, Royal Victoria Eye and Ear Hospital (RVEEH), Dublin, gave a presentation on the re-emergence of ‘old’ diseases such as syphilis and gonorrhoea, during the conference.

She said a small but significant number of patients complaining of eye problems at RVEEH in recent years have tested positive for the two sexually transmitted diseases (STIs). There have been 13 such cases caused by syphilis and 14 by gonorrhoea in the past few years at the hospital.

Long-term problems

Syphilis can cause blurred vision, pain in the eye, painful sensitivity to light and floaters in the patient’s vision. If left untreated it can result in more serious, long-term problems.

“If someone might have syphilis it is important to get the blood test done, which is very straightforward, as the treatment for syphilis would be very different than for the normal treatment of various eye conditions,” she told the conference.

Gonorrhoea, in a small minority of patients, can cause severe purulent conjunctivitis and eyelid swelling, which can be mistaken for standard conjunctivitis and/or keratitis.

In the past, ocular gonorrhoea was seen very rarely in Ireland, usually in newborn babies whose mothers had undiagnosed gonorrhoea. Now it is being seen in young adults, most frequently males, but also females, commonly aged under 25 years, Dr Knowles explained.

To treat these ocular issues, the gonorrhoea itself needs to be treated, typically with an antibiotic injection, compared to topical antibiotics for regular conjunctivitis or keratitis.

There has been a well-publicised, seven-fold rise in gonorrhoea cases in the east of Ireland in the past number of years (6.9 per 100,000 in 2003 rising to 49.2 per 100,000 in 2012), Dr Knowles noted.

Her presentation was well received and a number of ophthalmologists in the audience reported that they too had seen such cases, with at least one case causing a corneal melt. The doctors noted that due to a lack of awareness about the possibility of ocular issues being caused by an STI in general practice and general hospital medicine, diagnosis took some time and thus led to an unfortunate treatment delay.

Speaking to EuroTimes, Dr Knowles said she hoped increased awareness of the issue would make it easier for doctors to diagnose these cases and arrange the appropriate treatment as quickly as possible.

These cases typically present to emergency departments or GPs and, once diagnosed, should be referred to genito-urinary medicine/infectious disease clinics for other investigations and treatment, she said.

Susan Knowles: susan.knowles@rveeh.ie