Adult Inclusion Conjunctivitis - Causes, Symptoms, Diagnosis, and Treatment

What Is Adult Inclusion Conjunctivitis?

The bacteria, Chlamydia trachomatis, cause adult inclusion conjunctivitis. It is a sexually transmitted bacteria that causes an infection in the mucosal epithelium, leading to conjunctivitis. If it affects neonates, the resulting condition is called neonatal conjunctivitis. Conjunctivitis due to chlamydial infection is of the chronic follicular type, which lasts for more than 16 days to 28 days.

How Prevalent Is Adult Inclusion Conjunctivitis?

Of the total cases of acute conjunctivitis, adult inclusion of conjunctivitis caused by chlamydia contributes about 1.8 to 5.6 %. However, the percentage of individuals with chlamydial genital infections rises to about 54 % and 74 % in males and females, respectively. Adult inclusion conjunctivitis is commonly seen in adolescents and adults between the ages of 15 and 35 who are sexually active. Also, it has increased prevalence in females.

What Causes Adult Inclusion Conjunctivitis?

As said earlier, adult inclusion conjunctivitis is caused by the Chlamydia trachomatis. Of the different serotypes seen in this bacteria, serotypes D to K are responsible for adult inclusion conjunctivitis. In children, these serotypes cause ophthalmia neonatorum. About three-fourths of people also get genital infections from serotypes D to K. In rare cases, these serotypes are responsible for causing subacute follicular conjunctivitis.

Other subtypes of Chlamydia trachomatis are:

• Serotypes A to C - Trachoma (bacterial infection of the eyes that can cause blindness)

• Serotypes L1 to L3 - Lymphogranuloma venereum (chronic infection of the lymphatic system).

What Are the Predisposing Factors for Adult Inclusion Conjunctivitis?

• Adult age (15-35 years).

• Genital infection following sexual activity.

• Cervicitis, urethritis, prostatitis

• Proctitis( inflammation of rectum)

• Prevalence of chlamydial conjunctival infection in the sexual partner.

What Are the Symptoms of Adult Inclusion Conjunctivitis?

After getting infected with the bacteria, it takes around 4 days to 12 days to exhibit symptoms. Adult inclusion conjunctivitis usually affects only one eye, while both eyes can be involved in very few cases. Also, most individuals do not exhibit symptoms, and only 50 % of people show systemic symptoms.

The following are the symptoms of adult inclusion conjunctivitis:

• Pain and irritation.

• Itchiness in the eye.

• Watery eyes.

• Eyelid swelling.

• Redness in the eyes.

• Eyelashes stick to each other while waking up from sleep.

• Light sensitivity or photophobia.

• Foreign body sensation

• Muco-purulent discharges from the eyes.

In addition, the below systemic symptoms are also seen:

• Ear infection on the affected side.

• Urethritis (urethral inflammation).

• Vaginal discharge.

• Mild preauricular lymphadenopathy (swelling of lymph nodes in front of the ears).

What Are the Clinical Signs of Adult Inclusion Conjunctivitis?

1. Eyelids -

• Edema (swelling).

• Ptosis (drooping of upper eyelids).

• Involvement of preauricular lymph nodes.

2. Conjunctiva -

• Mucopurulent discharge.

• Follicles in both the upper and lower fornices.

• Hyperemia (excessive blood in the blood vessels supplying the organ).

• Chemosis (swelling in the eye surface).

• Limbal and bulbar follicles may be seen.

3. Cornea -

• Superior limbus pannus (fibrous ingrowth).

• Superior punctate keratitis (eye disorder caused by the death of some cells in the cornea).

• Presence of marginal and central infiltrates.

4. Iritis -

• Irritation of the iris, which is the colored part of the eye.

• A common type of uveitis.

• Redness, decreases vision, discomfort of the eye and sensitivity to light are some of the symptoms.

How Is Adult Inclusion Conjunctivitis Diagnosed?

1. Chlamydial Culture

Samples collected from the conjunctiva are sent for culture tests to look for the presence of chlamydia.

2. Polymerase Chain Reaction (PCR) Test

Test to identify the chlamydial infection. These are specific and sensitive tests and are among the best tests to identify adult inclusion conjunctivitis.

3. Serum Immunoglobulin G Titers

IgG antibodies are produced against the Chlamydia bacteria, which is detected in this test.

4. Giemsa Cytology

The Halberstaedter-Prowazek bodies present in the conjunctival scrapings are identified in this test. Although this test has more specificity, it lacks its sensitivity.

5. Direct Fluorescent Antibody Assay and Enzyme Immunoassay

These are also diagnostic tests that help detect adult inclusion conjunctivitis; however, they are less sensitive than polymerase chain reaction tests.

What Is the Differential Diagnosis of Adult Inclusion Conjunctivitis?

The following ocular conditions have similar clinical features and should be ruled out to ensure prompt and appropriate treatment:

• Molluscum contagiosum

• Trachoma.

• Allergic conjunctivitis.

• Viral conjunctivitis.

• Bacterial conjunctivitis.

• Superior limbic kerato-conjunctivitis.

• Epidemic kerato-conjunctivitis.

• Contact lens irritation.

How Is Adult Inclusion Conjunctivitis Managed?

A physician helps in managing the condition of adult inclusion conjunctivitis. Treatment for adult inclusion conjunctivitis is primarily aimed at preventing the occurrence of life-threatening complications.

Pharmacotherapy:

1. Systemic Antibiotics

The following are the antibodies that are given for systemic administration in the treatment of adult inclusion conjunctivitis and should be administered for three to six weeks.

• Erythromycin.

• Doxycycline.

• Azithromycin.

• Tetracycline.

2. Topical Antibiotics

• In adult inclusion conjunctivitis, topical antibiotic treatment is not as effective as systemic therapy and is not usually the first choice. This is because adult inclusion conjunctivitis is only an ocular presentation of a sexually transmitted infection.

• During the treatment for adult inclusion conjunctivitis, abstain from sexual activities. And all sexual partners and members in close contact should be treated.

• The patients generally start responding to the treatment in a couple of weeks. However, follow-up after six weeks.

What Are the Complications Associated With Adult Inclusion Conjunctivitis?

Just like having both ocular and systemic manifestations, complications that occur following an adult inclusion conjunctivitis are divided into:

1. Ocular Complications:

• Iritis (inflammation of the iris).

• Conjunctival scarring.

• Corneal micro-ulceration and micro-pannus.

• Punctate keratitis.

2. Systemic Complications:

• Urethritis.

• Vaginitis (vaginal inflammation).

• Cervicitis is associated with mucopurulent discharge.

• Pelvic inflammatory disease (PID) (infection of the organs of the reproductive system).

• In males, epididymitis is common.

• Reiter syndrome (inflammatory arthritis).

• Women with PID are more prone to develop Fitz-Hugh-Curtis Syndrome (inflammation of the liver capsule).

• Co-infections like gonorrhea.

• Peritonitis is caused by tubo-ovarian abscesses and chlamydial salpingitis.

• An ectopic pregnancy associated with chlamydial infection can cause death.

• Fertility issues in untreated women due to fallopian tube scarfing and pelvic inflammatory disease.

What Is the Prognosis of Adult Inclusion Conjunctivitis?

The prognosis is good if antibiotic therapy has been completed. However, untreated or new sexual partners who have been infected with chlamydia make reinfection possible.

How to Prevent Adult Inclusion Conjunctivitis?

Since adult inclusion conjunctivitis is in itself an ocular manifestation of chlamydia, preventing it serves the purpose. Chlamydia is a sexually transmitted disease, the most important preventive measure is to follow safe sexual practices.

The following are some beneficial sexual practices:

• Try and restrict to only one individual.

• Make sure your sexual partner is free of sexually transmitted infections.

• Do not engage in sexual activity with partners who have lesions or lumps in the skin or genital area.

• Follow barrier control methods of contraception to prevent disease acquisition.

Conclusion:

Adult inclusion conjunctivitis is an eye infection caused by a sexually transmitted disease, chlamydia. In most cases, it is not a fatal condition, and the prognosis is good with adequate treatment. Also, preventing the occurrence of adult inclusion conjunctivitis is simple when adequate safety measures are followed while engaging in sexual activity.