Definition

Inclusion conjunctivitis is an inflammation of the
conjunctiva (the membrane that lines the eyelids and
covers the white part, or sclera, of the eyeball) by
Chlamydia trachomatis. Chlamydia is a sexually transmitted
organism.

Description

Inclusion conjunctivitis, known as neonatal inclusion
conjunctivitis in the newborn and adult inclusion
conjunctivitis in the adult, is also called inclusion blennorrhea,
chlamydial conjunctivitis, or swimming pool
conjunctivitis. This disease affects four of 1,000 (0.4%)
live births. Approximately half of the infants born to
untreated infected mothers will develop the disease.

Causes and symptoms

Inclusion conjunctivitis in the newborn results from
passage through an infected birth canal and develops five
to 14 days after birth. Both eyelids and conjunctivae are
swollen. There may be a discharge of pus from the eyes.
Most instances of adult inclusion conjunctivitis
result from exposure to infected genital secretions. It is
transmitted to the eye by fingers and occasionally by the
water in swimming pools, poorly chlorinated hot tubs, or
by sharing makeup. In adult inclusion conjunctivitis, one
eye is usually involved, with a stringy discharge of
mucus and pus. There may be little bumps called follicles
inside the lower eyelid and the eye is red. Occasionally,
the condition damages the cornea, causing cloudy areas
and a growth of new blood vessels (neovascularization).

Diagnosis

Inclusion conjunctivitis is usually considered when
the patient has a follicular conjunctivitis that will not go
away, even after using topical antibiotics. Diagnosis
depends upon tests performed on the discharge from the
eye. Gram stains determine the type of microorganism,
while culture and sensitivity tests determine which
antibiotic will kill the harmful microorganism. Conjunctival
scraping determines whether chlamydia is present in
cells taken from the conjunctiva.

Treatment

Treatment in the newborn consists of administration
of tetracycline ointment to the conjunctiva and erythromycin
orally or through intravenous therapy for fourteen
days. The mother should be treated for cervicitis
and the father for urethritis, even if they do not have
symptoms of these diseases.

In adults, tetracycline ointment or drops should be
applied to the conjunctiva and oral tetracycline, amoxacillin,
or erythromycin should be taken for three weeks,
or doxycycline for one week.

Patients should have weekly checkups so that the
doctor can monitor the healing.

Oral tetracycline should not be administered to children
whose permanent teeth have not erupted. It should
also not be given to nursing or pregnant women.

Prognosis

Untreated inclusion conjunctivitis in the newborn persists
for three to 12 months and usually heals; however, there
may be scarring or neovascularization. In the adult, if left
untreated, the disease may continue for months and cause
corneal neovascularization. Even if the disease is treated,
antibiotics usually do not reverse damage that may have
occurred, but they may help prevent it if given early enough.

Prevention

The neonatal infection may be prevented by instilling
erythromycin ointment in the conjunctival cul-de-sac
at birth. It is not prevented by silver nitrate.

Chlamydia is a contagious, sexually transmitted disease.
Some systemic symptoms include a history of
vaginitis, pelvic inflammatory disease, or urethritis.
Patients with symptoms of these diseases should be treated
by a physician.