Background: Conjunctivitis is a familiar presentation in a pediatrician’s office, but sometimes the cause is less common. Ranging from viral, bacterial, allergic, and nonimmune etiologies, it is our job to take a detailed history and perform a thorough physical exam to determine the best therapy possible while preserving antibiotic stewardship and improving our patients’ outcomes.

Case Presentation: An 18 year old female presented to clinic for evaluation of worsening right eye redness, swelling, and blurred vision over the span of two weeks. Yellowish drainage in the morning caused her eye to “crust shut”, and though she used warm compresses to wipe it away, the drainage returned quickly. She had rhinorrhea with congestion, but denied fevers. Lubricating eye drops had not been helpful in alleviating her symptoms, and eye movement caused pain as well. When asking about social history, she admitted to being sexually active with inconsistent use of condoms. She did have vaginal discharge. She was afebrile, and physical exam was notable for significant conjunctival injection with copious purulent drainage and mild swelling around her eye. A urine GC/Chlamydia and pregnancy test were ordered along with a culture from the affected eye. The patient was started on ofloxacin 0.3% solution and amoxicillin/clavulanate 875-125 mg while waiting for confirmatory diagnosis and evaluation by an ophthalmologist. Her urine was positive for Gonorrhea the following day, and eventually her eye culture revealed Group A S. pyogenes and beta lactamase negative N. gonorrhoeae. The ophthalmologist agreed on continuing her ofloxacin 0.3% solution while stopping amoxicillin/clavulanate, and going to her pediatrician’s office to receive Rocephin 1000 mg intramuscularly. The patient’s symptoms vastly improved after her antibiotic therapies were completed, and was recommended to follow up with ophthalmology to monitor for any vision changes.

Discussion: There are different causes for conjunctivitis, viral being the most common in children, however there are cases of conjunctivitis that providers must address in a timely fashion to prevent blindness. Gonococcal conjunctivitis is a severe condition that requires urgent evaluation and treatment by an ophthalmologist due to concerns for corneal perforation leading to scarring and blindness. It is most commonly seen in neonates due to maternal infections, however pediatricians cannot forget that N. gonorrhoeae is the most common cause for bacterial conjunctivitis in sexually active teenagers and adults. Even though this patient was only being seen for conjunctivitis, one must never forget to ask about sexual history for this very reason.