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Chlamydial Conjunctivitis
Aka: Chlamydial Conjunctivitis, Chlamydia Conjunctivitis, Trachoma, Adult Inclusion Conjunctivitis, Neonatal Inclusion Conjunctivitis, Neonatal Inclusion Blennorrhea, Inclusion Conjunctivitis of the Newborn, Cicatricial Trachoma
- See Also
- Bacterial Conjunctivitis
- Conjunctivitis
- Epidemiology
- Trachoma responsible for 15% of world blindness
- History
- Trachoma first described in 16th Century B.C. Egypt
- Characteristics
- Trachoma
- Highest risk of Trachoma in first 3-6 years of life
- Associated with Chlamydia subtypes A-C
- Conjunctival scarring (Cicatricial Trachoma)
- Chronic follicular Conjunctivitis
- Chronic inflammation from recurrent infection
- Scarring complete by young adulthood
- Adult Inclusion Conjunctivitis (AIC)
- Affects <2% with genital tract Chlamydia
- Transmission
- Sexually Transmitted Infection (oculogenital)
- Historical: Non-chlorinated swimming pools (1900)
- Acute follicular Conjunctivitis >5 days post-exposure
- Neonatal Inclusion Conjunctivitis (NIC)
- Transmission during Vaginal Delivery
- Conjunctivitis onset 5-14 days after birth
- Associated with development of Chlamydia Pneumonia
- Initial watery discharge becomes copious and purulent
- Signs
- May present as subacute case (>4 weeks)
- Unilateral Conjunctivitis with hyperemia and mucopurulent discharge (stringy mucous discharge)
- Lymphoid follicle formation (also seen in some Viral Conjunctivitis)
- Tiny, rice grain size, gelatinous pale bumps on the Conjunctiva at fornix
- Labs
- Chlamydia trachomatis testing
- Nasal Swab for Chlamydia Direct Fluorescence Antibody (low Test Sensitivity) OR
- Chlamydia DNA Probe or NAAT (better Test Sensitivity)
- Causes
- Chlamydia trachomatis
- Less common Chlamydia Conjunctivitis causes
- Chlamydia pneumoniae
- Chlamydia psittaci
- Lymphogranuloma venereum
- Differential Diagnosis
- See Bacterial Conjunctivitis
- Epidemic Keratoconjunctivitis
- Gonorrheal Conjunctivitis (Newborns)
- Management
- Trachoma
- Azithromycin 20 mg/kg orally (up to 1 gram) for single dose (or Doxycycline 100 mg orally bid x21 days) AND
- Topical Tetracycline or Erythromycin ointment twice daily for 28 days
- Adult Inclusion Conjunctivitis (AIC)
- Azithromycin 1 g for 1 dose (or Doxycycline 100 mg twice daily for 7 days) AND
- Topical Erythromycin ointment to eye twice daily for 21 days
- Neonatal Inclusion Conjunctivitis (NIC)
- Erythromycin base or EES 50 mg/kg/day divided four times daily for 14 days
- Prevention
- Erythromycin or Tetracycline ophthalmic ointment
- Applied to newborns eyes within 1 hour of delivery
- Sexually Transmitted Disease Prevention
- Sexually Transmitted Disease surveillance in Pregnancy
- References
- Williams (2017) Crit Dec Emerg Med 31(2): 3-12
- Yanoff (1999) Ophthalmology, Mosby, p. 1.7
- Katusik (2003) Am J Ophthalmol 135(4): 447-51 [PubMed]
- Lietman (1999) Ophthalmol Clin North Am 12(1) [PubMed]
- Mabey (2005) Cochrane Database Syst Rev (2): CD001860 [PubMed]