Chlamydia conjunctivitis

Background

1. Two types:
   1. Trachoma
      1. Serotypes A through C
      2. Chronic keratoconjunctivitis
      3. Most common form of preventable blindness in the world
2. Inclusion conjunctivitis
   1. Serotypes D through K
   2. Common, primarily sexually transmitted disease
   3. Affects both newborns and adults

Diagnosis

Newborns

1. Tearing
2. Conjunctival inflammation
3. Eyelid swelling
4. Moderate discharge
5. Starting 5-12 days after birth

Adults

1. Infection can be subacute or chronic
2. Most common in young, sexually active persons aged 18 to 30 years
3. Unilateral or bilateral redness
4. Foreign body sensation
5. Mucopurulent discharge
6. Preauricular adenopathy

Differential Diagnosis

Conjunctivitis Types

• Viral conjunctivitis
  • Epidemic keratoconjunctivitis
  • Herpes zoster ophthalmicus
  • Herpes simplex keratitis
• Bacterial conjunctivitis
  • Gonorrheal conjunctivitis
  • Chlamydia conjunctivitis
• Allergic conjunctivitis
• Caustic keratoconjunctivitis

Treatment

Adult

1. Systemic antibiotics
2. Azithromycin 1g PO x 1
3. Topical antibiotics
   1. Topical erythromycin ointment BID-TID x 2-3 weeks
4. Consider CFTX for empiric gonorrhea coverage
5. Follow-up with ophtho within 1 week

Neonatal

Inclusion conjunctivitis

1. Systemic antibiotics
   1. Erythromycin elixir 50 mg/kg/d divided QID
2. Topical antibiotics
   1. Erythromycin ointment QID
3. Consultation with ophthalmology
   1. Special cultures may be required

See Also

Conjunctivitis

Source

• Mahmood AR, Narang AT. Diagnosis and management of the acute red eye. Emerg Med Clin N Am. 2008;26:35-55.