Inclusion conjunctivitis
Inclusion conjunctivitis: Excerpt from Professional Guide to Diseases (Eighth Edition)
Inclusion conjunctivitis (also called inclusion blennorrhea) is an acute ocular inflammation resulting from infection by Chlamydia trachomatis. Although inclusion conjunctivitis occasionally becomes chronic, the prognosis is usually good.
Causes and incidence
C. trachomatis is an obligate intracellular organism of the lymphogranuloma venereum serotype group. Serotypes D through K are sexually transmitted, and secondary eye involvement in adults occurs in about 1 in 300 genital cases. Because contaminated cervical secretions infect the eyes of the neonate during birth, inclusion conjunctivitis is an important cause of ophthalmia neonatorum. Ocular chlamydial disease occurs most frequently in adults between ages 18 and 30.
Signs and symptoms
Inclusion conjunctivitis develops 5 to 12 days after contamination (it takes longer to develop than gonococcal ophthalmia). In a neonate, reddened eyelids and tearing with moderate mucoid discharge are presenting symptoms. In neonates, pseudo-membranes may form, which can lead to conjunctival scarring. In 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 children may develop otitis media as a complication. Inclusion conjunctivitis may persist for weeks or months, possibly with superficial corneal involvement.
Diagnosis
Clinical features and a history of sexual contact with an infected individual suggest inclusion conjunctivitis.
Confirming diagnosis Examination of Giemsa-stained conjunctival scraping reveals cytoplasmic inclusion bodies in conjunctival epithelial cells, and is effective in detecting chlamydial infection in infants. The direct fluorescent monoclonal antibody and enzyme-linked immunosorbent assay are most effective in adults.
Treatment
Because infection isn’t limited to the eye in neonates, infants, or adults, systemic antimicrobial treatment is necessary. In infants, effective therapy is achieved with erythromycin. Adults may be given tetracycline, doxycycline, or erythromycin.
Prophylactic tetracycline or erythromycin ointment is applied once, 1 hour after delivery. However, this treatment hasn’t been found to be significantly more effective than Credé’s method (1% silver nitrate).
Special considerations
❑ Keep the patient’s eyes as clean as possible, using sterile 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 hands thoroughly before and after administering eye medications.
❑ Suggest genital examination of the mother of an infected neonate or of any adult with inclusion conjunctivitis.
❑ Obtain a history of recent sexual contacts, so they can be examined for chlamydial infection.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Conjunctival injection (Professional Guide to Signs & Symptoms (Fifth Edition))
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