Chlamydia conjunctivitis
Background
- Caused by Chlamydia
Conjunctivitis Types
Types
- Trachoma
- Serotypes A through C
- Chronic keratoconjunctivitis
- Most common form of preventable blindness in the world
- Inclusion conjunctivitis
- Serotypes D through K
- Common, primarily sexually transmitted disease
- Affects both newborns and adults
Clinical Features
Newborns
- Tearing
- Conjunctival inflammation
- Eyelid swelling
- Moderate discharge
- Starting 5-12 days after birth
Adults
- Infection can be subacute or chronic
- Most common in young, sexually active persons aged 18 to 30 years
- Unilateral or bilateral redness
- Foreign body sensation
- Mucopurulent discharge
- Pre-auricular adenopathy
Differential Diagnosis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses
^^Critical diagnoses
Bilateral red eyes
- Painful
- Painless
Evaluation
Workup
Diagnosis
Management
Adult
- Systemic antibiotics
- Azithromycin 1g PO x1 or doxycycline 100 mg BID for 7 days
- Topical antibiotics
- Topical erythromycin ointment BID-TID x2-3 weeks
- Consider ceftriaxone for empiric gonorrhea coverage
Neonatal
Inclusion conjunctivitis
- Systemic antibiotics
- Erythromycin elixir 50mg/kg/d divided QID
- Topical antibiotics
- Erythromycin ointment QID
- Consultation with ophthalmology
- Special cultures may be required
Disposition
- Discharge with ophtho follow-up.