Adult chlamydial conjunctivitis Adult chlamydial conjunctivitis is a sexually transmitted disease often found in conjunction with chlamydial urethritis or cervicitis. It is most prevalent in sexually active adolescents and young adults. Chlamydia is a systemic disease. The eye is usually infected by direct or indirect contact with infected genital secretions, although other modes of transmission may include shared eye cosmetics and inadequately chlorinated swimming pools. Onset of conjunctivitis is typically 1–2 weeks after ocular inoculation and is not as acute as with adenoviral keratoconjunctivitis. Often patients may report having had mild symptoms for weeks to months.
CLINICAL PRESENTATION External signs of adult inclusion conjunctivitis include a follicular conjunctival response that is most prominent in the lower palpebral conjunctiva and fornix, scant mucopurulent discharge, and palpable preauricular adenopathy. Follicles in the bulbar conjunctiva and semilunar fold are frequently present, and these are a helpful and specific sign in patients not using topical medications associated with the finding. Unlike with neonatal forms, inflammatory conjunctival membranes do not develop in adult chlamydial keratoconjunctivitis.
Corneal involvement may consist of fine or coarse epithelial infiltrates, occasionally associated with subepithelial infiltrates. The keratitis is more likely to be found in the superior cornea but may also occur centrally and resemble adenoviral keratitis. A micropannus, usually extending less than 3 mm from the superior cornea, may develop.
MANAGEMENT Left untreated, adult chlamydial conjunctivitis often resolves spontaneously in 6–18 months. Currently, one of the following oral antibiotic regimens is recommended:
azithromycin 1000 mg single dose doxycycline 100 mg twice daily for 7 days tetracycline 250 mg 4 times daily for 7 days erythromycin 500 mg 4 times daily for 7 days
Patients with laboratory-confirmed chlamydial conjunctivitis and their sexual contacts should be evaluated for coinfection with other sexually transmitted diseases, such as syphilis or gonorrhea, before antibiotic treatment is started. Sexual partners should be concomitantly treated to avoid reinfection.
Centers for Disease Control and Prevention; Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines 2006. MMWR Recomm Rep. 2006;55(RR-11):1–94.
Parinaud Oculoglandular Syndrome
Granulomatous conjunctivitis with regional lymphadenopathy is an uncommon condition called
Parinaud oculoglandular syndrome. Cat-scratch disease (CSD), which causes most cases of the syndrome, is estimated to affect 22,000 people annually in the United States, with approximately 10% developing conjunctivitis. The primary causative agent is B henselae. Other, infrequent causes of Parinaud oculoglandular syndrome include
Afipia felis
other Bartonella species tularemia
tuberculosis sporotrichosis syphilis