Chlamydial conjunctivitis. Allergic conjunctivitis.
Adult Chlamydial conjunctivitis (Paratrachom)
It is a sexual transmitted disease caused by the obligate intracellular bacterium chlamydia trachomatis serotypes D to K. Patients with Chlamydial conjunctivitis are generally young and at least 50% have a concomitant genital infection (cervicitis in women and urethritis in men) which may be asymptomatic. Transmission by autoinoculation from genital secretions although eye – to eye spread may occur rarely. Incobuation period is ~1 week
Ocular features
Presentation is with subacute onset of unilateral or bilatera, mucopurulent discharge. Unlike adenoviral infection, the conjunctivitis may persis for 3-12 monts if untreated.
Signs in chronological order
- eyelids may be slightly oedematous
- discharge is mucopurulent
- palpebral conjunctiva at first shows papilaoment hypertrophy, followed by developemtn of large follicles which are most prominent in the inferor forniceal conjunctiva but ma also involve the upper tarsal conjunctiva
- lymphadenopathy is non tender
- corneal involvement, although umcommon may take the form of epithelial keratitis, subepithelial opacities and marginal infiltrates
- longstanding cases are characterized by less prominen follicles but the development of mild conjunctival scarrind and a superior micropannus
Treatment
- topical therapy is with tetracyclineointment four times daily for 6 weeks
- systematic therapy with doxycycline/ tetracycline or erythromycin
Neonatal chlamydial conjunctivitis
Chlamydial infection is the most common cause of neonatal conjunctivitis, It may be associated with systemic chlamydial infection which may result in otitis, rhinitis and pneumonitis. Infection is transmiited from the mother during delivery.
Presentation is usually between 5 and 19 days after birth.
Signs
- papillary conjunctivitis with a mucopurulent discharge. The conjunctival reaction is papillary and not follicular because infants cannot form follicles until about the 3rd month of life
- occasional complications, if untreated include conjunctival scarrind and superior corneal pannus
Treatment
Is with topical tetracycline and oral ersythromycin ethyl succinate
Trachoma
It is an infection caused by serotypes A, B, Ba and C of Chlamydia trachomatis. It is a disease of populations with poor conditions of hygiene. The common fly is the major vector in the infection – reinfection cycle. Currently trachoma is the leading cause of preventable blindness in the world.
Clinical features
- presentation is during childhoof with the development of follicular conjunctivitis associated with diffuse papillary infiltration. In children under teh age of 2 years the papillar rreaction may be the predominant feature