Unusual Bilateral Self-Sealing Corneal Flaps in Neisseria gonorrhoeae Keratitis

This case report describes an unusual bilateral corneal perforation secondary to severe Neisseria gonorrhoeae keratoconjunctivitis and the development of a self-sealing conjunctival flap in an immunocompetent patient.

Interventional case report.

A prior healthy 42-year-old male presented with reduced vision, Neisseria gonorrhoeae conjunctivitis, and bilateral corneal perforation. Additionally, an unprecedented formation of a self-sealing conjunctival flap was observed in both eyes. Despite initial treatment with topical and intravenous broad-spectrum antibiotics, a tectonic penetrating keratoplasty was required to achieve visual recovery.

Adult gonococcal conjunctivitis (GC) typically occurs by direct inoculation and is usually unilateral. GC may be associated with severe infectious keratitis leading to corneal perforation. Tectonic corneal grafting combined with antimicrobial treatment had a favorable outcome in this extremely rare bilateral case.