Adult inclusion conjunctivitis, which makes up 1.8 to 5.6% of all cases of acute 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 months. Genital infections are present in up to 54% of males and 74% of females. Rarely, adult inclusion conjunctivitis is acquired from contaminated, incompletely chlorinated swimming pool water.
(See also Overview of Conjunctivitis Overview of Conjunctivitis Conjunctival inflammation typically results from infection, allergy, or irritation. Symptoms are conjunctival hyperemia and ocular discharge and, depending on the etiology, discomfort and itching... read more and Trachoma Trachoma Trachoma is a chronic conjunctivitis caused by Chlamydia trachomatis and is characterized by progressive exacerbations and remissions. It is the leading cause of preventable blindness worldwide... read more .)
Symptoms and Signs of Adult Inclusion Conjunctivitis
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.
Diagnosis of Adult Inclusion Conjunctivitis
Chronicity (symptoms for > 3 weeks), mucopurulent discharge, marked tarsal follicular response, and failure of topical antibiotics differentiate adult inclusion conjunctivitis from other bacterial conjunctivitides Acute Bacterial Conjunctivitis Acute conjunctivitis can be caused by numerous bacteria. Symptoms are hyperemia, lacrimation, irritation, and discharge. Diagnosis is clinical. Treatment is with topical antibiotics, augmented... read more . Smears, bacterial cultures, and chlamydial studies should be done. Immunofluorescent staining techniques, nucleic acid amplification tests (NAAT), 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
Treatment of Adult Inclusion Conjunctivitis
Oral azithromycin or doxycycline
Azithromycin 1 g orally once only or either doxycycline 100 mg orally twice a day or erythromycin 500 mg orally 4 times a day for 1 week cures the conjunctivitis and concomitant genital infection. Sex partners also require treatment.
Adult inclusion conjunctivitis is caused by Chlamydia trachomatis and is usually sexually acquired; in rare cases it can be acquired by swimming in a contaminated swimming pool.
The tarsal conjunctiva are usually more hyperemic than the bulbar conjunctiva; there is a marked tarsal follicular response.
Treat sex partners as well as the patient with oral azithromycin.