Inclusion Conjunctivitis

A fairly common, acute ocular inflammation, inclusion conjunctivitis results from infection by Chlamydia trachomatis. Also known as inclusion blennorrhea, the disease develops 5 to 10 days after contamination and may persist for weeks or months. If untreated, it runs a course of 3 to 9 months.

Causes

The microorganism C. trachomatis causes inclusion conjunctivitis. This pathogen, which usually infects the urethra in males and the cervix in females, may be transmitted during sexual activity. (Because contaminated cervical secretions can infect the eyes of the neonate during birth, the organism that causes inclusion conjunctivitis may contribute to some cases of ophthalmia neonatorum.) Rarely, inclusion conjunctivitis may result from autoinfection (a person transfers the virus from his genitourinary tract to his own eyes).

Symptoms

Inclusion conjunctivitis in the newborn results from passage through an infected birth canal and develops 5-14 days after birth. Both eyelids and conjunctivae are swollen. There may be a discharge of pus from the eyes

Diagnostic tests

Examination of Giemsa-stained conjunctival scrapings reveals cytoplasmic inclusion bodies in conjunctival epithelial cells and many polymorphonuclear leukocytes. Culture results are usually negative for bacteria.

Treatment

In infants, treatment consists of instilling eyedrops of 1 % tetracycline in oil, erythromycin ophthalmic ointment, or sulfonamide eyedrops five or six times daily for 2 weeks. To prevent ophthalmia neonatorum, neonates receive tetracycline or erythromycin ophthalmic ointment as a one-time dose 1 hour after birth.

For adults, treatment calls for administering oral tetracycline or erythromycin for 3 weeks. Severe disease may require concomitant systemic sulfonamide therapy. If the patient has associated uveitis, treatment may include corticosteroids and cycloplegic eye­drops.

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.

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