This is a sexually transmitted disease and is most prevalent in sexually active adolescents and young adults. Direct or indirect contact with genital secretions is the usual route of infections but shared eye cosmetics can also be involved. It is caused by Chlamydia trachomatis. Neonatal chlamydial conjunctivitis is a notifiable disease in the UK and should be suspected in newborns with a red eye. Mothers should be asked about sexually transmitted diseases. Trachoma caused by the same organism is found mainly in the tropics and the Middle East and is a very common cause of blindness in the world.

Clinical features

The onset of symptoms is slow, and patients may complain of mild discomfort for weeks. In these cases the red eye is associated with a scanty mucopurulent discharge and a palpable preauricular lymph node. In chronic cases it is not unusual to see superior corneal vascularization. In neonates the onset of the red eye is typically around 2 weeks after birth, whereas gonococcal conjunctivitis occurs within days of birth. Conjunctival swabs should be taken prior to commencement of treatment.

Treatment

Topical erythromycin twice daily is commenced and patients referred to the genitourinary physicians. Neonates should be started on topical erythromycin and referred to the paediatrician as there may be associated otitis media or pneumonitis.

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