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 <i>Neisseria gonorrhoeae</i>, 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.