Chlamydial conjunctivitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 1, 2016
StartDiseasesChlamydial conjunctivitis

Chlamydial conjunctivitis is a bacterial infection of the conjunctiva of one or both eyes. The infection is caused by the chlamydia bacteria. Infectious conjunctivitis can be caused by other bacteria or viruses; chlamydia is just one of many bacteria that can cause the conjunctiva to become infected. 

Contents

Definition & Facts

Chlamydia infection is a bacterial infection and a common sexually transmitted disease (STD). People who have this infection are usually asymptomatic, at least in the early stages. The infection is usually passed from one person to another through genital fluids and semen during unprotected oral, anal, or genital sex. It can be transmitted by genital contact that does not involve penetration.

When the chlamydia bacteria comes into contact with the eyes, it can cause chlamydial conjunctivitis. This infection can be passed from a pregnant mother to her child, resulting in neonatal conjunctivitis.

Both men and women can get chlamydia, but women are more likely to be diagnosed with chlamydia than men, especially younger women. Having sex with multiple partners without protection is the primary risk factor. Having an STD in the past or just having an infection could also increase the risk.

Because chlamydia infections generally have no symptoms, most people do not realize they have been infected. If symptoms appear at all, they usually don't show up for a few weeks after exposure to the infection. Symptoms can include lower abdominal pain, yellow or green vaginal discharge or penile discharge, burning during urination, painful intercourse in women and testicular pain in men.

If the infection travels to the fallopian tubes in women, pelvic inflammatory disease can develop. The infection can also develop in the anus, causing anal pain, anal bleeding and anal discharge. During oral sex, chlamydial bacteria can invade the throat and cause fever, cough, or sore throat.

Symptoms & Complaints

Symptoms of chlamydial conjunctivitis appear slowly and are similar to the symptoms of other types of conjunctivitis. Chlamydial conjunctivitis typically affects one eye first and then spreads to the other eye.

There is swelling of the clear membrane (called the conjunctiva) that covers the sclera or the whites of the eyes and lines the inside of the eyelids. Because the white part of the eye looks pink or red, conjunctivitis is often referred to as pink eye. Besides swelling and puffiness, there is irritation and inflammation.

There can be a watery or sticky eye discharge that causes the eyelids to stick together and makes opening the eyes difficult. Crusts can form around the corners of the eyes while sleeping, and eyes can feel itchy or scratchy. The discharge can become pus-like instead of watery, and the eyes may become sensitive to light.

Vision is not typically impaired, and there is usually no pain. However, mild eye pain can sometimes appear along with blurred vision and a sensation of sandiness. Infected newborns may have redness of the eyes, swelling of the eyelids and a watery discharge. Symptoms in newborns typically appear within a week after birth.

Causes

Bacterial conjunctivitis can be caused by numerous bacteria, including haemophilus influenzae, Staphylococcus aureus, and Streptococcus pneumoniae. Bacterial conjunctivitis is a common affliction in otherwise healthy people.

Chlamydial conjunctivitis in adults is usually caused by unprotected sex with someone who has a chlamydia infection. During or after sexual contact with an infected partner, the chlamydia bacteria comes into contact with one or both eyes via hand-to-eye contact where it then causes an infection. The infection typically spreads from one eye to the other, and it is easily spread from one person to another via secretions or discharges from the eyes of the infected person.

Contact with infected fluids can occur when sharing face cloths, towels, sheets, pillowcases, cosmetics or false eyelashes. Coming into contact with the bacteria and then touching the eyes without first washing the hands is how transmission usually takes place. 

Diagnosis & Tests

A diagnosis of chlamydial conjunctivitis can be made based on physical examination, a medical history, lab testing and symptoms that have been present for up to three weeks and include watery eyes or a purulent discharge. This condition often fails to respond to common antibiotic treatments.

Lab testing may include a swab or scrapings of the conjunctiva, smears, chlamydial studies and a culture of the eye discharge to determine the presence and type of bacteria present. Diagnosis should include a ruling out of other conditions since there are a variety of similar conditions that can mimic chlamydial conjunctivitis and present with the same symptoms.

Testing may include screening for other STDs, including HIV/AIDS, gonorrhea, and syphilis. Untreated chlamydial conjunctivitis can result in complications or an infectious eye disease called trachoma, which can result in blindness. This condition is rare in developed countries, but it is common in third-world countries in communities where there is poor hygiene.

Treatment & Therapy

Conjunctivitis is generally treated with antibiotics. However, the type of conjunctivitis caused by chlamydia often becomes a chronic condition that is resistant to topical antibiotics. Although the condition does not typically affect vision, prompt treatment is recommended to prevent complications.

Although complications can and do occur, the condition usually does not progress beyond the initial symptoms. If the infection goes untreated, the condition can persist for years. In newborns, the infection is also self-limiting, but persistent or untreated infection can cause conjunctival scarring and may spread to the respiratory tract and cause pneumonia.

Treatment generally consists of warm compresses, topical antibacterial ointments or eye drops, and oral tetracycline and erythromycin. Contact lenses and sexual activity should be avoided until healing is complete, and any underlying conditions should be treated.

Crusting discharge should be removed with damp sterile cotton. Lubricating eye drops can be used if eyes are dry, and a saline solution can be used to reduce mucus. The condition generally improves after three or four weeks of treatment. Babies should be treated early with IV antibiotics and antibiotic ointments to prevent blindness and lung infections. Both the eyes and the body must be treated for chlamydia infection. Sexual partners should be screened and treated as well. 

Prevention & Prophylaxis

Chlamydial conjunctivitis can be prevented by good hygienic practices which include the following:

  • Avoid face cloths, pillows, sheets or towels that are used by others.
  • Use condoms during sexual activity
  • Avoid touching eyes during or after sexual activity
  • Wash hands after sexual contact
  • Do not share cosmetics or false eyelashes with others
  • If one eye is affected, protect the unaffected eye from infection
  • Get screened for chlamydia every year and when pregnant
  • Wash hands frequently
  • Avoid touching eyes or wiping away tears with fingers without washing hands