Conjunctivitis, Chlamydial (adult inclusion conjunctivitis)
The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care.
The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care.
The microorganism Chlamydia trachomatis is an obligate intracellular parasite (i.e. it cannot replicate outside a host cell)
Most common in young adulthood (15-35 years)
Sexual activity leading to genital infection with C. trachomatis:
History usually more than two weeks
Ocular gritty sensation and sticky discharge
Drooping upper lid(s)
(the majority of cases are unilateral)
Lid and other features
Conjunctival features
Corneal features
(NB signs may be unilateral or asymmetrical or bilateral)
Other causes of acute red eye such as adenovirus keratoconjunctivitis, HSK, molluscum contagiosum
Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere
Advise against contact lens wear
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
Symptomatic relief with ocular lubricants
(NB even if diagnosis appears beyond doubt, do not commence specific treatment before referral as other STDs may also be present)
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
A3: first aid measures and urgent referral to ophthalmologist or GP with a view to onward referral to Genito-Urinary Clinic
Laboratory testing to confirm diagnosis
Liaison with Genito-Urinary Clinic, which will exclude other STDs and advise on treatment of patient and partner(s).
Treatment with systemic antibiotics (e.g. single dose of azithromycin or a short course of doxycycline). Patients and sexual partners must be treated
*GRADE: Grading of Recommendations Assessment, Development and Evaluation (www.gradingworkinggroup.org)
Sources of evidence
Azari AA, Barney NP. Conjunctivitis: a systematic review of diagnosis and treatment. JAMA. 2013;310:1721-9
Katusic D, Petricek I, Mandic Z, Petric I, Salopek-Rabatic J, Kruzic V, Oreskovic K, Sikic J, Petricek G. Azithromycin vs doxycycline in the treatment of inclusion conjunctivitis. Am J Ophthalmol 2003;135:447-51
Mohamed-Noriega K, Mohamed-Noriega J, Valdés-Navarro MA, Cuervo-Lozano EE, Fernández-Espinosa MC, Mohamed-Hamsho J. Conjunctival infection with Chlamydia trachomatis in sexual partners of patients with adult inclusion conjunctivitis. Int Ophthalmol. 2015;35(2):179-85
Chlamydia is one of the most common sexually transmitted infections (STIs) in the UK.
In the eyes, chlamydia can cause irritation, pain, swelling and discharge, usually affecting one eye only. Most patients presenting with chlamydial conjunctivitis will have an associated genital infection (of which they may be unaware). It is important that these patients are referred to genito-urinary medicine clinics for a full STI investigation. Chlamydial infection is usually treated with antibiotics, which can be very effective. Most people with chlamydial infection will be cured if they take their antibiotics correctly.
Conjunctivitis, Chlamydial (adult inclusion conjunctivitis)
Version 13
Date of search 27.09.18
Date of revision 28.09.18
Date of publication 17.04.19
Date for review 26.09.20
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