Perforated Corneal Ulcer Arising From Gonococcal Keratoconjunctivitis: A Report of Three Cases

This report aims to raise awareness among ophthalmologists about gonococcal keratitis, which may present with peripheral corneal thinning and ulceration accompanied by mucopurulent discharge. A high index of suspicion facilitates early diagnosis, timely intervention, and improved visual outcomes. We describe three cases: a 49-year-old male presenting with right eye redness, vision loss, and purulent discharge from both the eye and urethra, whose examination revealed peripheral corneal thinning with perforation and iris plugging; a 28-year-old healthy male with a two-day history of decreased visual acuity, photophobia, and purulent discharge in the left eye, with findings of a corneal perforation at the 10 o'clock position and peripheral thinning; and a 19-year-old male reporting seven days of right eye redness, purulent discharge, lid swelling, and vision loss, preceded by a five-day history of urethral discharge and dysuria, with examination showing peripheral corneal thinning and ulceration with corneal perforation. Corneal swabs from all three patients tested positive for Neisseria gonorrhoeae, confirming gonococcal keratoconjunctivitis leading to corneal perforation. They were treated with intravenous ceftriaxone (2 g daily for 14 days) and topical antibiotics, and all subsequently underwent corneal transplantation. In conclusion, gonococcal keratoconjunctivitis is a rapidly progressive condition that can result in corneal perforation, endophthalmitis, and blindness, underscoring the critical need for early recognition and prompt ophthalmologic referral.