History
Adult inclusion conjunctivitis presents as a unilateral (or less commonly bilateral) red eye with mucopurulent discharge, marked hyperemia, papillary hypertrophy, and a predominant follicular conjunctivitis.
Women often have a concomitant vaginal discharge secondary to chronic vaginitis and/or cervicitis. Men may have symptomatic or nonsymptomatic urethritis.
Conjunctivitis often is chronic and may last for many months.
Inquire about duration of symptoms, prior treatment, and recent and not-so-recent sexual exposure.
Physical
Inferior tarsal conjunctival follicles are obvious, and a tender enlarged preauricular lymph node is common.
Keratitis may develop during the second week after onset.
Corneal involvement includes a superficial punctate keratitis, small marginal or central infiltrates, epidemic keratoconjunctivitis (EKC)–like subepithelial infiltrates, limbal swelling, and a superior limbal pannus. [4] The subepithelial infiltrates tend to be more peripheral than after EKC.
Untreated disease has a chronic remittent course, and keratitis and possibly iritis occur more commonly in the late stage of disease.
Causes
Adult inclusion conjunctivitis is a sexually transmitted disease.
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This image reveals a close view of a patient's left eye with the upper lid retracted in order to reveal the inflamed conjunctival membrane lining the inside of both the upper and lower lids, due to what was determined to be a case of inclusion conjunctivitis, a type of conjunctival inflammation caused by the bacterium, Chlamydia trachomatis. Inclusion conjunctivitis, also known as chlamydial conjunctivitis, is more common in newborns. Symptoms include redness of the eye(s), swelling of the eyelids, and discharge of pus, usually 5 to 12 days after birth. Image courtesy of Susan Lindsley, Centers for Disease Control and Prevention.
