Ophthalmologic Manifestations of Chlamydia

Updated: Feb 12, 2024
  • Author: Jonathan C Tsui, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Overview

Background

Chlamydiae are obligate intracellular bacteria including the three species: Chlamydia trachomatis, Chlamydia psittaci, and Chlamydia pneumoniae.

C trachomatis, which is almost exclusively a human pathogen, includes the agents of classic trachoma (serotypes A, B, Ba, C) and agents of inclusion conjunctivitis or paratrachoma (serotypes D-K). The latter organisms infect the epithelium of mucoid surfaces and once were identified as the trachoma-inclusion conjunctivitis agents (TRIC). Serotypes L1, L2, and L3, the agents that infect tissues deeper to the epithelium and cause lymphogranuloma venereum, also are included. [1]

C trachomatis is the most common cause of chronic follicular conjunctivitis (ie, follicular conjunctivitis lasting for >16-28 days). The organism also causes 3 clinical syndromes, which include the following: trachoma, adult inclusion conjunctivitis, and neonatal conjunctivitis. Trachoma and neonatal conjunctivitis are discussed in other reference articles; therefore; this discussion focuses on adult inclusion conjunctivitis . [1]

Adult inclusion conjunctivitis results from C trachomatis serotypes D-K, causing chronic follicular conjunctivitis that can occur in adults or in the neonate. The adult disease typically is transmitted sexually or from hand-to-eye contact. Gonorrhea is the most common co-infection with adult inclusion conjunctivitis. Rarely, the adult disease is transmitted from eye-to-eye contact (eg, sharing mascara). [1, 2]

This image reveals a close view of a patient's lef This image reveals a close view of a patient's left eye with the upper lid retracted in order to reveal the inflamed conjunctival membrane lining the inside of both the upper and lower lids, due to what was determined to be a case of inclusion conjunctivitis, a type of conjunctival inflammation caused by the bacterium, Chlamydia trachomatis. Inclusion conjunctivitis, also known as chlamydial conjunctivitis, is more common in newborns. Symptoms include redness of the eye(s), swelling of the eyelids, and discharge of pus, usually 5 to 12 days after birth. Image courtesy of Susan Lindsley, Centers for Disease Control and Prevention.

Also see the Medscape Reference article Chlamydial Genitourinary Infections.

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Pathophysiology

The epidemiology of this disease revolves around sexual contact. Modes of transmission include orogenital activities, hand-to-eye spread of infective genital secretions, and even direct ejaculate into the eye. [3] Although rare, eye-to-eye contact spread has been reported (eg, sharing mascara). The incubation period is 4-12 days.

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Epidemiology

Frequency

United States

An estimated 1 in 300 patients who have genital chlamydial disease develop adult inclusion conjunctivitis. [4]

Sex

Similar in other types of chlaymida, women are considered to be more susceptible than men to adult inclusion conjunctivitis. [5]

Age

Usually, this condition is observed in the young sexually active population. It is most common in persons aged 15-35 years. [6]

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Prognosis

Prognosis is excellent with treatment. [6]

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Patient Education

Educate patients about the risks for sexually transmitted diseases and safe sexual practices.

For patient education resources, see publicly available information on Sexually Transmitted Diseases from the CDC as well as publicly available material for patients on Chlamydia.

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