eMedicine Specialties > Ophthalmology > Infectious Disease

Chlamydia

Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Contributor Information and Disclosures

Updated: Nov 2, 2007

Introduction

Background

Chlamydiae are obligate intracellular organisms from bacteria that now comprise 3 species. They include the following: Chlamydia trachomatis, Chlamydia psittaci, and Chlamydia pneumoniae.

C trachomatis, which is almost exclusively a human pathogen, includes the agents of classic trachoma (ie, serotypes A, B, Ba, C). It also includes the agents of inclusion conjunctivitis or paratrachoma (ie, serotypes D-K). The latter organisms infect the epithelium of mucoid surfaces and were once identified as the trachoma-inclusion conjunctivitis agents (TRIC). Serotypes L1, L2, and L3, the agents that infect tissues deeper to the epithelium and cause lymphogranuloma venereum, also are included.

C trachomatis is the most common cause of chronic follicular conjunctivitis (ie, follicular conjunctivitis lasting for >16-28 d). The organism also causes 3 clinical syndromes, which include the following: trachoma, adult inclusion conjunctivitis, and neonatal conjunctivitis. Trachoma and neonatal conjunctivitis are discussed in other chapters so this discussion is restricted to adult inclusion conjunctivitis.

Adult inclusion conjunctivitis results from C trachomatis serotypes D-K, causing chronic follicular conjunctivitis that can occur in adults or in the neonate. The adult disease is transmitted sexually or from hand-to-eye contact. Gonorrhea is the most common co-infection with adult inclusion conjunctivitis. Rarely, the adult disease is transmitted from eye-to-eye contact (eg, sharing mascara).

Pathophysiology

The epidemiology of this disease revolves around sexual contact. Modes of transmission include orogenital activities, hand-to-eye spread of infective genital secretions, and even direct ejaculate into the eye1 Although rare, eye-to-eye contact spread has been reported (eg, sharing mascara). The incubation period is 4-12 days.

Frequency

United States

It is estimated that 1 in 300 patients who have genital chlamydial disease develop adult inclusion conjunctivitis.

Sex

No difference in frequency of disease between the sexes has been reported.

Age

Usually, this condition is observed in the young sexually active population. It is most common in persons aged 15-35 years.

Clinical

History

  • Adult inclusion conjunctivitis presents as a unilateral (or less commonly bilateral) red eye with mucopurulent discharge, marked hyperemia, papillary hypertrophy, and a predominant follicular conjunctivitis.
  • Women often have a concomitant vaginal discharge secondary to chronic vaginitis and/or cervicitis. Men may have symptomatic or nonsymptomatic urethritis.
  • Conjunctivitis often is chronic and may last for many months.
  • Inquire about duration of symptoms, prior treatment, and recent and not-so-recent sexual exposure.

Physical

  • Inferior tarsal conjunctival follicles are obvious, and a tender enlarged preauricular lymph node is common.
  • Keratitis may develop during the second week after onset.
    • Corneal involvement includes a superficial punctate keratitis, small marginal or central infiltrates, epidemic keratoconjunctivitis (EKC)–like subepithelial infiltrates, limbal swelling, and a superior limbal pannus. The subepithelial infiltrates tend to be more peripheral than after EKC.
    • Untreated disease has a chronic remittent course, and keratitis and possibly iritis occur more commonly in the late stage of disease.

Causes

Adult inclusion conjunctivitis is a sexually transmitted disease.


More on Chlamydia

Overview: Chlamydia
Differential Diagnoses & Workup: Chlamydia
Treatment & Medication: Chlamydia
Follow-up: Chlamydia
References
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References

  1. Rackstraw S, Viswalingam ND, Goh BT. Can chlamydial conjunctivitis result from direct ejaculation into the eye?. Int J STD AIDS. Sep 2006;17(9):639-41. [Medline].

  2. Bersudsky V, Rehany U, Tendler Y, Leffler E, Selah S, Rumelt S. Diagnosis of chlamydial infection by direct enzyme-linked immunoassay and polymerase chain reaction in patients with acute follicular conjunctivitis. Graefes Arch Clin Exp Ophthalmol. Aug 1999;237(8):617-20. [Medline].

  3. Carta F, Zanetti S, Pinna A, Sotgiu M, Fadda G. The treatment and follow up of adult chlamydial ophthalmia. Br J Ophthalmol. Mar 1994;78(3):206-8. [Medline].

  4. Coppens I, Abu el-Asrar AM, Maudgal PC, Missotten L. Incidence and clinical presentation of chlamydial keratoconjunctivitis: a preliminary study. Int Ophthalmol. 1988;12(4):201-5. [Medline].

  5. Elnifro EM, Storey CC, Morris DJ, Tullo AB. Polymerase chain reaction for detection of Chlamydia trachomatis in conjunctival swabs. Br J Ophthalmol. Jun 1997;81(6):497-500. [Medline].

  6. Haller-Schober EM, El-Shabrawi Y. Chlamydial conjunctivitis (in adults), uveitis, and reactive arthritis, including SARA. Sexually acquired reactive arthritis. Best Pract Res Clin Obstet Gynaecol. Dec 2002;16(6):815-28. [Medline].

  7. Kalayoglu MV. Ocular chlamydial infections: pathogenesis and emerging treatment strategies. Curr Drug Targets Infect Disord. Mar 2002;2(1):85-91. [Medline].

  8. Miller K, Schmidt G, Melese M. How reliable is the clinical exam in detecting ocular chlamydial infection?. Ophthalmic Epidemiol. Jul 2004;11(3):255-62. [Medline].

  9. Nakagawa H. Treatment of chlamydial conjunctivitis. Ophthalmologica. 1997;211 Suppl 1:25-8. [Medline].

  10. Numazaki K, Chiba S, Aoki K. Evaluation of serological tests for screening of chlamydial eye diseases. In Vivo. May-Jun 1999;13(3):235-7. [Medline].

  11. Salopek-Rabatic J. Chlamydial conjunctivitis in contact lens wearers: successful treatment with single dose azithromycin. CLAO J. Oct 2001;27(4):209-11. [Medline].

  12. Stenberg K, Mardh PA. Genital infection with Chlamydia trachomatis in patients with chlamydial conjunctivitis: unexplained results. Sex Transm Dis. Jan-Mar 1991;18(1):1-4. [Medline].

  13. Taylor HR, Fitch CP, Murillo-Lopez F, Rapoza P. The diagnosis and treatment of chlamydial conjunctivitis. Int Ophthalmol. 1988;12(2):95-9. [Medline].

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Further Reading

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Keywords

chlamydiae, Chlamydia trachomatis, Chlamydia psittaci, Chlamydia pneumoniae, C trachomatis, C psittaci, C pneumoniae, adult inclusion conjunctivitis, trachoma, paratrachoma, chronic follicular conjunctivitis, sexually transmitted disease, STD, genital chlamydial disease, gonorrhea

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Contributor Information and Disclosures

Author

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Fernando H Murillo-Lopez, MD, Senior Surgeon, Unidad Privada de Oftalmologia CEMES
Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Hospital
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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