Merck Manual

Please confirm that you are a health care professional

Loading

Adult Inclusion Conjunctivitis

(Adult Chlamydial Conjunctivitis; Swimming Pool Conjunctivitis)

By

Melvin I. Roat

, MD, FACS, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Oct 2019| Content last modified Oct 2019
Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
Topic Resources

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 months. 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.

Diagnosis

  • Clinical evaluation

  • Laboratory testing

Chronicity (symptoms for > 3 weeks), 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, 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

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

Treatment

  • 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.

Key Points

  • 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.

Drugs Mentioned In This Article

Drug Name Select Trade
ERY-TAB, ERYTHROCIN
ZITHROMAX
PERIOSTAT, VIBRAMYCIN
Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
Professionals also read

Also of Interest

Videos

View All
How To Do Lateral Canthotomy
Video
How To Do Lateral Canthotomy

SOCIAL MEDIA

TOP