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Chlamydial Conjunctivitis

Chlamydial conjunctivitis

What is it?
Chlamydial conjunctivitis is an infection by Chlamydia trachomatis that occurs in two forms:

  • neonatal type: acquired from an infected cervix. Most common cause of red eye in a newborn.
  • adult type: acquired by sexual contact. Causes a chronic indolent conjunctivitis resistant to standard topical antibiotics.
How does it present?
  • neonatal type: diffusely hyperemic conjunctiva with onset from day 2 to week 8 after birth; pneumonitis common.
  • adult type: chronic, low-grade conjunctival hyperemia, usually affecting the inferior bulbar and palpebral conjunctiva with prominent mounds called follicles.
Diagnosis is made by finding typical elementary bodies on direct fluorescent antibody stain of conjunctival scrapings. Conjunctival culture may grow the organisms but it takes weeks.

What to do?
Send conjunctival scraping in Chlamydia collection kit to microbiology laboratory to search for elementary bodies by direct fluorescent antibody stain.

For neonates, prescribe topical tetracycline ointment 4 times daily for 4 weeks and oral erythromycin for 4 weeks.

For adults, prescribe oral doxycycline or erythromycin for 4 weeks.

Treat parents and sexual partners with adult regimen.

Refer infants urgently and adults nonurgently if conjunctivitis does not improve or worsens after 5 days of treatment.

Refer adults non-urgently if conjunctivitis lingers after treatment ends.

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