Chlamydial Conjunctivitis

Aka: Chlamydial Conjunctivitis, Chlamydia Conjunctivitis, Trachoma, Adult Inclusion Conjunctivitis, Neonatal Inclusion Conjunctivitis, Neonatal Inclusion Blennorrhea, Inclusion Conjunctivitis of the Newborn, Cicatricial Trachoma

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II. Epidemiology

  1. Trachoma responsible for 15% of world blindness

III. History

  1. Trachoma first described in 16th Century B.C. Egypt

IV. Characteristics

  1. Trachoma
    1. Highest risk of Trachoma in first 3-6 years of life
    2. Associated with Chlamydia subtypes A-C
    3. Conjunctival scarring (Cicatricial Trachoma)
      1. Chronic follicular Conjunctivitis
      2. Chronic inflammation from recurrent infection
      3. Scarring complete by young adulthood
  2. Adult Inclusion Conjunctivitis (AIC)
    1. Affects <2% with genital tract Chlamydia
    2. Transmission
      1. Sexually Transmitted Infection (oculogenital)
      2. Historical: Non-chlorinated swimming pools (1900)
    3. Acute follicular Conjunctivitis >5 days post-exposure
  3. Neonatal Inclusion Conjunctivitis (NIC)
    1. Transmission during Vaginal Delivery
    2. Conjunctivitis onset 5-14 days after birth
    3. Associated with development of Chlamydia Pneumonia
    4. Initial watery discharge becomes copious and purulent

V. Signs

  1. May present as subacute case (>4 weeks)
  2. Unilateral Conjunctivitis with hyperemia and mucopurulent discharge (stringy mucous discharge)
  3. Lymphoid follicle formation (also seen in some Viral Conjunctivitis)
    1. Tiny, rice grain size, gelatinous pale bumps on the Conjunctiva at fornix

VI. Labs

  1. Chlamydia trachomatis testing
    1. Nasal Swab for Chlamydia Direct Fluorescence Antibody (low Test Sensitivity) OR
    2. Chlamydia DNA Probe or NAAT (better Test Sensitivity)

VII. Causes

  1. Chlamydia trachomatis
  2. Less common Chlamydia Conjunctivitis causes
    1. Chlamydia pneumoniae
    2. Chlamydia psittaci
    3. Lymphogranuloma venereum

VIII. Differential Diagnosis

  1. See Bacterial Conjunctivitis
  2. Epidemic Keratoconjunctivitis
  3. Gonorrheal Conjunctivitis (Newborns)

IX. Management

  1. Trachoma
    1. Azithromycin 20 mg/kg orally (up to 1 gram) for single dose (or Doxycycline 100 mg orally bid x21 days) AND
    2. Topical Tetracycline or Erythromycin ointment twice daily for 28 days
  2. Adult Inclusion Conjunctivitis (AIC)
    1. Azithromycin 1 g for 1 dose (or Doxycycline 100 mg twice daily for 7 days) AND
    2. Topical Erythromycin ointment to eye twice daily for 21 days
  3. Neonatal Inclusion Conjunctivitis (NIC)
    1. Erythromycin Base or EES 50 mg/kg/day divided four times daily for 14 days

X. Prevention

  1. Erythromycin or Tetracycline ophthalmic ointment
    1. Applied to newborns eyes within 1 hour of delivery
  2. Sexually Transmitted Disease Prevention
  3. Sexually Transmitted Disease surveillance in Pregnancy

XI. References

  1. Williams (2017) Crit Dec Emerg Med 31(2): 3-12
  2. Yanoff (1999) Ophthalmology, Mosby, p. 1.7
  3. Katusik (2003) Am J Ophthalmol 135(4): 447-51 [PubMed]
  4. Lietman (1999) Ophthalmol Clin North Am 12(1) [PubMed]
  5. Mabey (2005) Cochrane Database Syst Rev (2): CD001860 [PubMed]

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