Inclusion Conjunctivitis

Inclusion conjunctivitis is an acute ocular inflammation resulting from infection by Chlamydia trachomatis. Although inclusion conjunctivitis occasionally becomes chronic, the prognosis is generally good with treatment. If untreated, it may run a course of 3 to 9 months.

Causes

C. trachomatis is an obligate intracellular organism. It usually infects the urethra in males and the cervix in females and is transmitted during sexual activity.

Because contaminated cervical secretions infect the eyes of the neonate during birth, inclusion conjunctivitis is an important cause of ophthalmia neonatorum. Rarely, inclusion conjunctivitis results from autoinfection, by hand to-eye transfer of the organism from the genitourinary tract.

Signs and symptoms

Inclusion conjunctivitis develops 5 to 10 days after contamination (it takes longer to develop than gonococcal ophthalmia). In a neonate, the lower eyelids redden and a thick, purulent discharge develops. In children and adults, follicles appear inside the lower eyelids; such follicles don't form in infants because the lymphoid tissue isn't yet well developed. Children and adults also develop preauricular lymphadenopathy and, as complications, otitis media and, occasionally, interstitial pneumonia.

Inclusion conjunctivitis may persist for weeks or months, possibly with superficial corneal involvement. In neonates, pseudomembranes may form, which can lead to conjunctival scarring.

Diagnosis

Clinical features and a history of sexual contact with an infected person suggest inclusion conjunctivitis. Examination of Giemsa-stained conjunctival scraping reveals cytoplasmic inclusion bodies in conjunctival epithelial cells, many polymorphonuclear leukocytes, and a negative culture for bacteria.

Treatment

Treatment consists of eye drops of 1% tetracycline in oil, erythromycin ophthalmic ointment, or sulfonamide eye drops five or six times daily for 2 weeks for infants and oral tetracycline or erythromycin for 3 weeks for adults. In severe disease, adults may require concomitant systemic sulfonamide therapy. The patient's sexual partner should also be examined and treated.

Prophylactic tetracycline or erythromycin ointment is applied once 1 hour after delivery.

Prevention

The neonatal infection may be prevented by instilling erythromycin ointment in the conjunctival cul-de-sac at birth. It is not prevented by silver nitrate.

Chlamydia is a contagious, sexually transmitted disease. Some systemic symptoms include a history of vaginitis, pelvic inflammatory disease , or urethritis. Patients with symptoms of these diseases should be treated by a physician.