ADULT INCLUSION CONJUNCTIVITIS

Adult Inclusion conjunctivitis is a type of acute follicular conjunctivitis associated with mucopurulent discharge. It usually affects the
sexually active young adults.

Etiology
Inclusion conjunctivitis is caused by serotypes D to
K of Chlamydia trachomatis. The primary source of
infection is urethritis in males and cervicitis in
females.
The transmission of infection may occur to eyes
either through contaminated fingers or more
commonly through contaminated water of swimming
pools (hence the name swimming pool
conjunctivitis).

Clinical features
Incubation period of the disease is 4-12 days.

Symptoms are similar to acute mucopurulent
conjunctivitis and include:

• Ocular discomfort, foreign body sensation,
• Mild photophobia, and
• Mucopurulent discharge from the eyes.

Signs of inclusion conjunctivitis are:

• Conjunctival hyperaemia, more marked in fornices.
• Acute follicular hypertrophy predominantly of lower palpebral conjunctiva (Fig. 1).
• Superficial keratitis in upper half of cornea. Sometimes, superior micropannus may also occur.
• Pre-auricular lymphadenopathy is a usual finding

  

  Fig. 1. Signs of acute follicular conjunctivitis.

  
  

Clinical course. The disease runs a benign course
and often evolves into the chronic follicular
conjunctivitis.
Differential diagnosis must be made from other
causes of acute follicular conjunctivitis.

Treatment
1. Topical therapy. It consists of tetracycline (1%)
eye ointment 4 times a day for 6 weeks.

2. Systemic therapy is very important, since the
condition is often associated with an
asymptomatic venereal infection. Commonly
employed antibiotics are:

• Tetracycline 250 mg four times a day for 3-4 weeks.
• Erythromycin 250 mg four times a day for 3-4 weeks (only when the tetracycline is contraindicated e.g., in pregnant and lactating females).
• Doxycycline 100 mg twice a day for 1-2 weeks or 200 mg weekly for 3 weeks is an effective alternative to tetracycline.
• Azithromycin 1 gm as a single dose is also effective.

Prophylaxis
Improvement in personal hygiene and regular chlorination of swimming pool water will definitely decrease the spread of disease. Patient's sexual
partner should be examined and treated.