Chlamydial conjunctivitis is an infectious lesion of the mucous membrane of the eyes with chlamydia, accompanied by acute or chronic inflammation of the conjunctiva. Chlamydial conjunctivitis occurs with swelling of the conjunctiva and transitional folds, purulent discharge from the eyes, lacrimation, pain in the eyes, follicular rashes on the lower eyelid, parotid adenopathy, eustachian phenomena. Diagnosis of chlamydial conjunctivitis consists in conducting biomicroscopy, cytological, cultural, enzyme immunoassay, immunofluorescence, PCR studies to determine chlamydia. Treatment is carried out with tetracycline antibiotics, macrolides and fluoroquinolones until complete clinical and laboratory recovery.
74.0 Chlamydial conjunctivitis
Chlamydial conjunctivitis (ophthalmohlamydia, chlamydia of the eyes) accounts for 3-30% of the number of conjunctivitis of various etiologies. Chlamydia of the eyes is more common in people aged 20-30 years, while women get chlamydial conjunctivitis 2-3 times more often than men. Disease occurs mainly against the background of urogenital chlamydia (urethritis, colpitis, cervicitis), which can occur in an erased form and not disturb the patient. Therefore, chlamydial infections are included in the field of ophthalmology, venereology, urology, gynecology.
Characteristics of the pathogen
Chlamydial conjunctivitis is caused by the intracellular microorganism Chlamydia trachomatis, which exhibits the properties of bacteria and viruses. Forming the so-called L-forms, chlamydia are capable of long-term parasitism inside cells in an inactive, “dormant” state. Under various unfavorable conditions (taking antibiotics, hypothermia, acute respiratory viral infections, overheating), during the period of immunosuppression, there is an “awakening” (reversion) of chlamydia from L-forms and active reproduction with the development of clinical symptoms.
Different antigenic serotypes of chlamydia cause various lesions: for example, serotypes A, B, Ba and C lead to the development of trachoma; serotypes D – K – to the occurrence of adult paratrachoma, epidemic chlamydial conjunctivitis, urogenital chlamydia; serotypes L1-L3 – to the development of inguinal lymphogranulomatosis.
Ways of infection
In most cases, disease occurs against the background of chlamydia of the genitourinary tract: according to statistics, about 50% of patients with ophthalmochlamydia also have a urogenital form of infection. In adults, ocular chlamydia develops as a result of the introduction of the pathogen into the conjunctival sac from the genitals through hygiene items and hands contaminated with secretions. At the same time, the carrier of genitourinary chlamydia can infect not only his organ of vision, but also the eyes of his healthy partner. Often, this disease is a consequence of oral-genital sexual contact with an infected partner.
There are cases of professional infection with chlamydial conjunctivitis among obstetricians, gynecologists, venereologists, urologists, andrologists, ophthalmologists examining patients with various forms of chlamydia.
Infection with chlamydial conjunctivitis is possible through water when visiting public pools and baths. This form of the disease has been called “pool” or “bath” conjunctivitis and can often take on the character of epidemic outbreaks.
Chlamydial conjunctivitis in newborns can develop due to intrauterine (transplacental) infection or infection of the eyes during childbirth from a mother with chlamydia. Chlamydial eye infection occurs in 5-10% of newborns.
There is an increased risk of developing of this disease:
- sexually active men and women;
- patients with chlamydia of the urogenital tract; family members (including children) where there are patients with genital or ocular chlamydia;
- medical specialists;
- persons visiting public baths, saunas, swimming pools;
- children born from mothers suffering from chlamydia.
Chlamydial lesion can occur in the form of:
- Of adult chlamydial conjunctivitis (paratrachomas)
- Of neonatal chlamydial conjunctivitis (blennorrhea)
- Basin conjunctivitis
- Epidemic chlamydial conjunctivitis of children
- Chlamydial conjunctivitis in Reiter ‘s syndrome
- Chlamydial conjunctivitis (meibomitis) of zoonotic nature.
In addition, other forms of ophthalmic chlamydia are distinguished in ophthalmology: chlamydial keratitis, chlamydial uveitis, chlamydial episcleritis, etc.
Clinical manifestations develop after the incubation period (5-14 days). As a rule, one eye is initially affected, bilateral infection occurs in 30% of patients. In 65% of cases, chlamydial conjunctivitis occurs in the form of acute or subacute eye infection, in other cases – in a chronic variant.
With a chronic course, sluggish, often recurrent blepharitis or conjunctivitis with moderately pronounced symptoms are noted: slight swelling of the eyelids and hyperemia of conjunctival tissue, mucous discharge from the eyes.
Acute chlamydial conjunctivitis and exacerbation of chronic forms are accompanied by pronounced swelling and infiltration of the mucous membrane of the eyes and transitional folds, photophobia and lacrimation, pain in the eyes, copious separation of mucopurulent or purulent secretions from the eyes gluing the eyelids. Pathognomonic development on the side of the lesion of painless regional anterior adenopathy, as well as eustacheitis, characterized by pain and noise in the ear, hearing loss.
Visual examination of the eyes on the conjunctiva determines multiple follicles, delicate fibrinous films, which, as a rule, dissolve without scarring. The acute phase of chlamydial conjunctivitis lasts from 2 weeks to 3 months.
Newborns and young children, in addition to pronounced ocular symptoms, often develop chlamydial pneumonia, nasopharyngitis, rhinitis, acute otitis, eustachiitis. Complications in the form of lacrimal-nasal stenosis, conjunctival scarring are not uncommon.
Chlamydial conjunctivitis may accompany the course of an autoimmune disease – Reiter’s syndrome, but the pathogenesis of ophthalmohlamydia in this pathology has not been fully studied. Eye damage in Reiter’s syndrome can occur in the form of chlamydial conjunctivitis, keratitis, iridocyclitis, chorioiditis, retinitis.
Diagnostic tactics in case of suspicion of chlamydial conjunctivitis provides for ophthalmological examination, laboratory tests, consultations of related specialists (venereologist, gynecologist, urologist, rheumatologist, otolaryngologist).
- Ophthalmological diagnostics. Biomicroscopy of the eye using a slit lamp reveals characteristic edema, infiltration and vascularization of the limb. To exclude corneal lesions, an instillation fluorescein test is performed. Ophthalmoscopy is used to assess the condition of the retina and uveal tract.
- Laboratory diagnostics. Laboratory studies play a leading role in confirming the diagnosis of chlamydial conjunctivitis. The optimal combination is a combination of various methods of isolation of chlamydia in scraping from the conjunctiva (cytological, immunofluorescence, culture, PCR) and antibodies in the blood (ELISA). If necessary, patients are prescribed an examination for urogenital chlamydia.
Chlamydia of the eyes must be differentiated from bacterial and adenoviral conjunctivitis.
Etiotropic drugs for chlamydial conjunctivitis are antibiotics: fluoroquinolones, macrolides, tetracyclines. Local therapy includes instillation of antibacterial eye drops (r-r ofloxacin, r-r ciprofloxacin), ointment applications for the eyelids (tetracycline ointment, erythromycin ointment), the use of anti-inflammatory drops (r-r indomethacin, r-r dexamethasone).
Systemic treatment of chlamydia is carried out according to the STI therapy scheme. The criteria for the cure are: regression of clinical symptoms, negative data from laboratory tests conducted 2-4 weeks after the end of the course of treatment and three subsequent analyses taken at intervals of one month.
Prognosis and prevention
The consequences can be different. With rational therapy, the disease, as a rule, ends with a complete recovery. Quite often, chlamydial conjunctivitis acquires a recurrent course. The outcome of recurrent forms of ophthalmochlamydia may be scarring of the conjunctiva and cornea of the eyes, leading to a decrease in vision.
Prevention requires timely detection and treatment of urogenital chlamydia in adults (including pregnant women), the use of individual hygiene items in the family, eye protection with glasses when swimming in the pool, the use of protective equipment by medical personnel.