Conjunctiva Inclusion Conjunctivitis

Epidemiology: Inclusion conjunctivitis is very frequent in temperate countries. The incidence in western industrialized countries ranges between 1.7% and 24% of all sexually active adults depending on the specific population studied.

Etiology: Oculogenital infection (Chlamydia trachomatis serotype D-K) is also caused by direct contact. In the newborn (see neonatal conjunctivitis), this occurs at birth through the cervical secretion. In adults, it is primarily transmitted during sexual intercourse, and rarely from infection in poorly chlorinated swimming pools.

Symptoms: The eyes are only moderately red and slightly sticky from viscous discharge.

Diagnostic considerations: Tarsal follicles are observed typically on the upper and lower eyelids, and pannus will be seen to spread across the limbus of the cornea. As this is an oculogenital infection, it is essential to determine whether the mother has any history of vaginitis, cervicitis, or urethritis if there is clinical suspicion of neonatal infection. Gynecologic or urologic examination is indicated in appropriate cases. Chlamydia may be detected in conjunctival smears, by immunofluorescence, or in tissue cultures. Typical cytologic signs include basophilic cytoplasmic inclusion bodies (Fig. 4.13).

Treatment: In adults, the disorder is treated with tetracycline or erythromy-cin eyedrops or ointment over a period of four to six weeks. The oculogenital mode of infection entails a risk of reinfection. Therefore, patients and sexual

Chlamydial conjunctivitis.

— Chlamydial conjunctivitis.

Fig. 4.13 Cytologic smear showing typical basophilic cyto-plasmic inclusion bodies.

partners of treated patients should all be treated simultaneously with oral tetracycline. Children should be treated with erythromycin instead of tetracycline (see the table in the Appendix for side effects of medications).

Prognosis: The prognosis is good when the sexual partner is included in therapy.

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