Chlamydial Conjunctivitis

Question 1

Aetiology

Answer 1

C trachomatis is obligate intracellular parasite meaning it cannot replicate outside the host. It is spread via direct contact, hand to eye, fomites. It can cause 3 types of conjunctivitis
- Adult inclusion conjunctivitis - chronic follicular conjunctivitis, serotypes D-K, incubation period of 1-2 weeks
- Ophthalmia Neonatorum.
- Trachoma.

Question 2

Predisposing factors

Answer 2

Young adulthood - 15 to 35 year olds
sexual activity leading to genital infection with chlamydia - may also have inflammation of urethra, prostate, rectum, cervix. May be asymptomatic.

Question 3

Symptoms

Answer 3

Mildly persistent red eye for weeks to months
Droopy eyelid - unilateral but can be bilateral
Blurred vision
Sticky mucus discharge
Ocular gritty sensation

Question 4

Signs

Answer 4

Lid oedema +/- mechanical ptosis
Large follicles in palpebral conjunctiva
Limbal and bulbar follicles may be present
Conjunctival hyperaemia and chemosis
Mucopurulent discharge
Cornea - pannus, superior punctate keratitis, SEI/marginal infiltrates

Question 5

Non pharmacological management

Answer 5

cease CL wear

Question 6

Pharmacological management

Answer 6

even if diagnosis is clear, do. not commence treatment until diagnosis has been confirmed
ocular lubricants

REFER URGENTLY TO OPHTHALMOLOGY OR GP WITH VIEW OF ONWARD REFERRAL TO GENITO URINARY CLINICS

Question 7

HES management

Answer 7

Confirm diagnosis with PCR testing
Liase with Genito urinary clinic to identify other STI and manage with sexual partners
Single doze azithromycin or short course of doxycycline .