Inclusion Conjunctivitis

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Have you suffered from redness and irritation of the eyes? Do your symptoms come and go only to return again? Has your vision gotten blurry with your symptoms? Are you a sexually active young adult? If you answered yes to most of these questions, you may have Adult Inclusion Conjunctivitis (AIC).

AIC results from exposure to infective genital tract discharge. The disease is transmitted by autoinoculation from the genital tract or by genital-to-eye inoculation from an infected sexual partner.

Ocular transmission can also arise from laboratory accidents, a mother infecting the newborn, shared cosmetics, or (occasionally) an improperly chlorinated hot tub. AIC can be associated with urethritis or vaginitis. It usually affects one eye.

AIC is most common in young, sexually active adults and in populations with high venereal disease rates. The condition usually occurs after having acquired a new sexual partner in the preceding 2 months. The acute conjunctivitis often evolves into a chronic follicular conjunctivitis. Follicles are “bumps” in the conjunctiva lining the inner eyelids, which point to a lymphocytic response. Lymphocytic pertains to white blood cells functioning in cellular immunity.

What are the signs and symptoms of Inclusion Conjunctivitis?

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Redness and irritation

Mucopurulent discharge

Waxing and waning of symptoms

Chronic follicles on upper and lower tarsus (conjunctiva lining the eyelids)

Palpable preauricular node (a bump under the skin in the area in front of the ear)

Superficial Punctate Keratitis (SPK) is marked by dryness of the cornea and small dots of positive staining when fluorescein dye is instilled in the eye.

Subepithelial Infiltrates are cloudy, whitish spots in the cornea that indicate inflammation.

How can Inclusion Conjunctivitis be Diagnosed?

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Chlamydia trachomatis is an intracellular parasite that ranks among the more important causes of conjunctivitis. Diagnosis by Giemsa-stained scraping of the epithelium is less likely to show inclusion bodies, but these may be seen in a number of patients with the acute disease.

An inclusion body is an abnormal structure in a cell nucleus or cytoplasm having characteristic staining properties. Ocular signs that may help in making the diagnosis include an epithelial keratitis, as well as marginal and more central corneal infiltrates accompanied by superficial vascularization (or new blood vessel growth).

This new blood vessel growth points to the chronic nature of this condition. More severe complications include iritis (inflammation located inside the eye), which can occur later in the condition, and Reiter’s Syndrome, which is an autoimmune condition. Because it is a systemic condition (i.e., it affects your whole body, not only your eyes), you should get treated for genital chlamydial infection with 100 mg oral Doxycycline twice per day.

You should continue treatment until your conjunctiva’s follicles fade away, which may take several weeks. A single one gram dose of Azithromycin is an equally effective treatment, and might be the best option in many circumstances-as in pregnancy.

Doxycycline, the preferred drug, has been found to affect the infant’s skeletal and dental development. Also, make sure your partner gets treated as well. If your partner is a sexually-active female of childbearing age, she may be better off taking Azithromycin because it has less potential of causing birth defects if she were pregnant.

Given that this infection can affect both your eyes and your body, you, as well as your sexual partner, should be examined and treated systemically. If left untreated, sterility/infertility can develop in both sexes.

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