Infection of the conjunctiva by chlamydia trachomatis
Different serotypes cause different kinds of infections
Serotypes A, B, C cause trachoma, affecting over 150 million adults worldwide, but especially in Middle East, Africa, Asia
Serotypes D, E, F, G, H, I, K cause neonatal and adult inclusion conjunctivitis
Neonatal inclusion conjunctivitis, commonest cause of red eye in newborns, acquired from infected cervix, produces diffuse engorgement of conjunctival vessels, follicles, minimal mucous discharge
Adult inclusion conjunctivitis, acquired by sexual contact, produces chronic low-grade engorgement of conjunctival vessels, follicles, minimal mucous discharge
Trachoma, commonest cause of worldwide preventable blindness, produces intense superior conjunctival follicles, conjunctival scarring, corneal pannus and opacification
Neonatal inclusion conjunctivitis: moderate-grade engorgement of conjunctival vessels starting from day 2 to week 8 after birth; baby may also have pneumonitis
Adult inclusion conjunctivitis: chronic hyperemia and follicles of inferior bulbar and palpebral conjunctiva
Send conjunctival scraping in chlamydia collection kit to microbiology laboratory in search of elementary bodies by direct fluorescent antibody stain
For neonatal inclusion conjunctivitis, prescribe erythromcyin 12.5mg/kg orally or intravenously for 14 days
For adult inclusion conjunctivitis, prescribe oral tetracycline 250mg 4 times daily for 3 weeks, or oral doxycycline 100mg 2 times daily for 3 weeks, or erythromycin 500mg 4 times daily for 3 weeks
For trachoma, prescribe topical tetracycline 1% or erythromycin ointment 2 times daily for 2 months and oral tetracycline 2gm daily
Treat parents and sexual partners with adult regimen
Refer infants urgently and adults non-urgently if conjunctivitis does not improve or worsens after 5 days of treatment
Refer adults non-urgently if conjunctivitis lingers after treatment ends
Once proper treatment of inclusion conjunctivitis begins, manifestations usually resolve within weeks without permanent damage to eyes
Treatment of trachoma poses challenges: scarring, dry eye, corneal opacification not reversible; compliance with treatment not consistent; reinfection via houseflies and household objects very high
