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Related to inclusion conjunctivitis: lymphogranuloma venereum, ophthalmia neonatorum, chlamydia, chlamydial conjunctivitis, follicular conjunctivitis
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.
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 5-14 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).
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. Conjuntival scraping determines whether chlamydia is present in cells taken from the conjunctiva.
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 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.
Untreated inclusion conjunctivitis in the newborn persists for 3-12 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 treated, antibiotics usually do not reverse damage that may have occurred, but they may help prevent it if given early enough.
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.
Newell, Frank W. Ophthalmology: Principles and Concepts. 8th ed. St. Louis: Mosby, 1996.
American Academy of Ophthalmology. 655 Beach Street, PO Box 7424, San Francisco, CA 94120-7424. http://www.eyenet.org.
American Optometric Association. 243 North Lindbergh Blvd., St. Louis, MO 63141. (314) 991-4100. http://www.aoanet.org.
Cervicitis — Cervicitis is an inflammation of the cervix or neck of the uterus.
Conjunctiva — The conjunctiva is the membrane that lines the eyelids and covers the white part of the eyeball (sclera).
Cornea — The clear dome-shaped structure that covers the colored part of the eye (iris).
Neovascularization — Neovascularization is the growth of new blood vessels.
Urethritis — Urethritis is an inflammation of the urethra, the canal for the discharge of urine that extends from the bladder to the outside of the body.
inflammation of the conjunctiva; it may be caused by bacteria or a virus, or by allergic, chemical, or physical factors. Its infectious form (of bacterial or viral origin) is highly contagious. See also pinkeye.
acute contagious conjunctivitis a contagious inflammation of the conjunctiva caused by Haemophilus aegypticus; secretions must be handled with extreme care to prevent its spread. Popularly known as pinkeye.
acute hemorrhagic conjunctivitis a highly contagious form due to infection with enteroviruses.
gonococcal conjunctivitis (gonorrheal conjunctivitis) a severe form caused by infection with gonococci, marked by greatly swollen conjunctivae and eyelids with a profuse purulent discharge. In newborns it is bilateral, acquired from an infected maternal vaginal passage. In adults it is usually unilateral and is acquired by autoinoculation into the eye of other gonococcal infections, such as urethritis, either in oneself or in another person. Called also gonorrheal ophthalmia.
inclusion conjunctivitis a type of conjunctivitis primarily affecting newborn infants, caused by a strain of Chlamydia trachomatis, beginning as an acute purulent form and leading to papillary hypertrophy of the palpebral conjunctiva.
neonatal conjunctivitis ophthalmia neonatorum.
a follicular conjunctivitis caused by Chlamydia trachomatis.
an acute purulent conjunctival infection caused by Chlamydia organisms. It occurs in two forms: the infection in infants is characterized by bilateral chemosis, redness, and purulent discharge. The adult variety is unilateral, less severe, and less purulent and is associated with preauricular lymphadenopathy. Local instillation of antibiotics is effective treatment.
in·clu·sion con·junc·ti·vi·tis(in-klū'zhŭn kŏn-jŭngk'ti-vī'tis)
A follicular conjunctivitis caused by Chlamydia trachomatis.