Inclusion conjunctivitis
Inclusion conjunctivitis: Excerpt from Handbook of Diseases
Inclusion conjunctivitis, or chlamydia keratoconjunctivitis, is an acute ocular inflammation resulting from infection by Chlamydia trachomatis — serotypes A through C (trachoma) and D through K (inclusion conjunctivitis). Trachoma is a major cause of worldwide blindness. Although inclusion conjunctivitis occasionally becomes chronic, the prognosis is generally good with treatment. If untreated, it may run a course of 3 to 9 months.
Causes
C. trachomatis is an obligate intracellular organism. It usually infects the urethra in males and the cervix in females and is transmitted during sexual activity.
Because contaminated cervical secretions infect the eyes of the neonate during birth, inclusion conjunctivitis is an important cause of ophthalmia neonatorum. Rarely, inclusion conjunctivitis results from autoinfection, by hand-to-eye transfer of the organism from the genitourinary tract.
Signs and symptoms
Inclusion conjunctivitis develops 5 to 10 days after contamination (it takes longer to develop than gonococcal ophthalmia). In neonates, the lower eyelids redden and a thick, purulent discharge develops. In children and adults, follicles appear inside the lower eyelids; such follicles don’t form in infants because the lymphoid tissue isn’t yet well developed. Children and adults also develop preauricular lymphadenopathy and — as complications, otitis media and, occasionally, interstitial pneumonia.
Inclusion conjunctivitis may persist for weeks or months, possibly with superficial corneal involvement. In neonates, pseudomembranes may form, which can lead to conjunctival scarring.
Diagnosis
Signs and symptoms and a history of sexual contact with an infected person suggest inclusion conjunctivitis. Examination of stained conjunctival scraping reveals cytoplasmic inclusion bodies in conjunctival epithelial cells, many polymorphonuclear leukocytes, and a negative culture for bacteria.
Treatment
Treatment consists of 1% tetracycline eyedrops, erythromycin ophthalmic ointment, or sulfonamide eyedrops five or six times daily for 2 weeks for infants and oral tetracycline or erythromycin for 3 weeks for adults. Adults with severe disease may also require systemic therapy. Sexual partners should also be examined and treated.
Prophylactic tetracycline or erythromycin ointment is applied once, 1 hour after delivery.
Clinical tip The Credé prophylaxis doesn’t protect against inclusion conjunctivitis.
Special considerations
❑ Keep the patient’s eyes as clean as possible, using aseptic technique. Clean the eyes from the inner to the outer canthus. Apply warm soaks as needed. Record the amount and color of drainage.
❑ Remind the patient not to rub his eyes, which can irritate them.
❑ If the patient’s eyes are sensitive to light, keep the room dark or suggest that he wear dark glasses.
❑ To prevent further spread of inclusion conjunctivitis, wash your hands thoroughly before and after administering eye medications.
❑ Suggest a pelvic examination for the mother of an infected neonate or for any adult with inclusion conjunctivitis.
❑ Obtain a history of recent sexual partners so they can be examined for inclusion conjunctivitis.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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