Ophthalmologic Manifestations of Chlamydia 

  • Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Apr 9, 2012
 

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).

Also see the Medscape Reference articles Chlamydia (Emergency Medicine) and Chlamydial Genitourinary Infections (Infectious Diseases).

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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 eye.[1] Although rare, eye-to-eye contact spread has been reported (eg, sharing mascara). The incubation period is 4-12 days.

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Epidemiology

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.

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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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; RPS Ownership interest Other; EyeGate Pharma Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting; Merck Honoraria Speaking and teaching

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.

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. 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].

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

  4. 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].

  5. Blake IM, Burton MJ, Bailey RL, Solomon AW, West S, Muñoz B, et al. Estimating Household and Community Transmission of Ocular Chlamydia trachomatis. PLoS Negl Trop Dis. 2009;3(3):e401. [Medline].

  6. [Guideline] American Academy of Ophthalmology Cornea/External Disease Panel. Conjunctivitis. National Guideline Clearinghouse. 2008.

  7. [Guideline] U.S. Preventive Services Task Force. Behavioral counseling to prevent sexually transmitted infections: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. Oct 7 2008;149(7):491-6, W95. [Medline].

  8. 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].

  9. 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].

  10. 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].

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

  12. 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].

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

  14. 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].

  15. 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].

  16. 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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