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Inclusion Conjunctivitis - Causes, Symptoms and Treatment

Definition:

Inclusion conjunctivitis is an acute ocular inflammation resulting from infection by the bacterium Chlamydia trachomatis. Although inclusion conjunctivitis occasionally becomes chronic, the prognosis is generally good with treatment. If untreated, the disease may run a course of 3 to 9 months.

Causes of Inclusion Conjunctivitis

The main cause of inclusion conjunctivitis is a bacterium named, Chlamydia trachomatis. It is a bacterium of the lymphogranuloma venereum serotype D to K that is sexually transmitted. Secondary eye involvement in adults occurs in 1 out of 300 genital cases.

Because contaminated cervical secretions infect the eyes of the neonate during birth, inclusion conjunctivitis is an important cause of ophthalmia neonatorum.

Signs and Symptoms of Inclusion Conjunctivitis

Inclusion conjunctivitis develops 5 to 12 days after infection from the bacterium. In a neonate, the eyelids redden and tearing with moderate mucoid discharge is a presenting symptom. Also, in neonates, pseudomembranes may form, which can lead to conjunctival scarring. In adults, follicles appear inside the lower eyelids; such follicles are not formed in infants because 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.

Diagnosis of Inclusion Conjunctivitis

Clinical features and a history of sexual contact with an infected person suggest inclusion conjunctivitis. Examination of Giemsa-stained conjunctival scraping showing cytoplasmic inclusion bodies in conjunctival epithelial cells is effective in detecting neonatal and infant chlamydial infections. The direct fluorescent monoclonal antibody (DFA) test and enzyme linked immunosorbent assay (ELISA) test are more effective in adults.

Treatment for Inclusion Conjunctivitis

Because treatment is not limited to the eye in either neonates, infant, or adults, systemic anti microbial treatment is necessary. Administration of erythromycin base for neonates and infants is fairly effective - 80% for the first course of treatment. Sometimes a second course of erythromycin is needed.

Tetracycline may be given to adults and children over age of 8 years. Erythromycin base is used in the treatment of younger children and pregnant women. The patient's sexual partner should also be examined.

Special Considerations and Prevention Tips for Inclusion Conjunctivitis

  • Keep the patient's eyes as clean as possible, using aseptic technique. Clean the eyes from the inner to the outer canthus. Record the amount and color of drainage. Apply warm soaks as needed.
  • Remind the patient not to rub his eyes, which can irritate them and possible spread the infection.
  • 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 woman who has inclusion conjunctivitis.
  • Obtain a history of recent sexual contacts so they can be examined and, if necessary, treated for chlamydial infection.

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