Adult inclusion conjunctivitis or Paratrachoma results due to infection by obligate intracellular bacterium, Chlamydia trachomatis (serotypes D to K), which causes chronic follicular conjunctivitis (follicular conjunctivitis lasting for more than 16- 28 days). These organisms infect the epithelium of mucoid surfaces and were once identified as the trachoma-inclusion conjunctivitis agents (TRIC agents). These organisms can also infect a neonate during birth and may lead to neonatal conjunctivitis.
Chlamydia trachomatis also includes the agents of classic trachoma (serotypes A, B, Ba and C). Lymphogranuloma venereum, a sexually transmitted infection, is caused by Chlamydia trachomatis (serotypes L1 to L3) which infect tissues deeper to the epithelium.
Adult inclusion conjunctivitis is transmitted sexually (oro-genital activities) or from hand-to-eye contact. Gonorrhoea is the most common co-infection associated with adult inclusion conjunctivitis. Rarely, adult inclusion conjunctivitis is transmitted through eye-to-eye contact (e.g. by sharing mascara).
Kanski,Jack J. Clinical Ophthalmology, A Systematic Approach .Third Edition.UK. Butterworth Heinemann, 1994.
Symptoms do not always exist with adult inclusion conjunctivitis in large number of patients and is often transmitted unknowingly.
Almost half of patients with adult inclusion conjunctivitis do not have a systemic infection of Chlamydia. In addition to eye, Chlamydiae are found in parts of the body with mucosal membrane such as respiratory tract and the genitourinary tract.
Symptoms of adult inclusion conjunctivitis may wax and wane and the patient may be asymptomatic.
Patient may present with symptoms like:-
Ocular (Eye) symptoms:
- Red eye.
- Muco-purulent discharge.
- Sticking of eyelashes on awakening.
- Irritation of eyes.
- Foreign body sensation.
- Photophobia or intolerance to light.
- Swelling of eyelids.
- Urethritis in males.
- Genito-urinary symptoms viz. urethritis, vaginal discharge in females.
- Mild ear infection on same side of infected eye.
-Mild pre-auricular lymphadenopathy.