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Adult Inclusion Conjunctivitis

(Adult Chlamydial Conjunctivitis; Swimming Pool Conjunctivitis)

By Melvin I. Roat, MD, FACS, Clinical Associate Professor of Ophthalmology; Cornea Service, Sidney Kimmel Medical College at Thomas Jefferson University; Wills Eye Hospital

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Adult inclusion conjunctivitis is caused by sexually transmitted Chlamydia trachomatis. Symptoms include chronic unilateral hyperemia and mucopurulent discharge. Diagnosis is clinical. Treatment is with systemic antibiotics.

Adult inclusion conjunctivitis is caused by Chlamydia trachomatis serotypes D through K. In most instances, adult inclusion conjunctivitis results from sexual contact with a person who has a genital infection. Usually, patients have acquired a new sex partner in the preceding 2 mo. Rarely, adult inclusion conjunctivitis is acquired from contaminated, incompletely chlorinated swimming pool water.

Symptoms and Signs

Adult inclusion conjunctivitis has an incubation period of 2 to 19 days. Most patients have a unilateral mucopurulent discharge. The tarsal conjunctiva is often more hyperemic than the bulbar conjunctiva. Characteristically, there is a marked tarsal follicular response. Occasionally, superior corneal opacities and vascularization occur. Preauricular lymph nodes may be swollen on the side of the involved eye. Often, symptoms have been present for many weeks or months and have not responded to topical antibiotics.


  • Clinical evaluation

  • Laboratory testing

Chronicity (symptoms for > 3 wk), mucopurulent discharge, marked tarsal follicular response, and failure of topical antibiotics differentiate adult inclusion conjunctivitis from other bacterial conjunctivitides. Smears, bacterial cultures, and chlamydial studies should be done. Immunofluorescent staining techniques, PCR, and special cultures are used to detect C. trachomatis. Smears and conjunctival scrapings should be examined microscopically and stained with Gram stain to identify bacteria and stained with Giemsa stain to identify the characteristic epithelial cell basophilic cytoplasmic inclusion bodies of chlamydial conjunctivitis.

Pearls & Pitfalls

  • If patients have symptoms of bacterial conjunctivitis plus a marked tarsal follicular response (often with mucopurulent discharge), symptoms for > 3 wk, or failure to respond to topical antibiotics, do smears, bacterial cultures, and chlamydial studies.


  • Oral azithromycin or doxycycline

Azithromycin 1 g po once only or either doxycycline 100 mg po bid or erythromycin 500 mg po qid for 1 wk cures the conjunctivitis and concomitant genital infection. Sex partners also require treatment.

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