Letters to the Editor
Features and Serotypes of Chlamydial Conjunctivitis
FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.
FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.
Am Fam Physician. 2012 Jan 1;85(1):6.
Original Article: Diagnosis and Management of Red Eye in Primary Care
Issue Date: January 15, 2010
Available at: http://www.aafp.org/afp/2010/0115/p137.html
to the editor: The article on management of red eye was well written; however, a few omissions are worthy of mention. Table 1 of the article shows that there is no corneal involvement with chlamydial inclusion conjuntivitis, and that Chlamydia trachomatis (serotypes D and K) is the causative organism. The corresponding text states that chlamydial conjunctivitis should be suspected in sexually active patients who do not respond to standard antibacterial treatments. However, important features of this disease were omitted, and the serotypes were not differentiated.
Chlamydial eye involvement, known as trachoma, is endemic in many parts of the world and is a major cause of blindness. It involves the cornea, initially as superficial keratitis. Later, trachomatous pannus (vascularization of the normally avascular cornea) develops as a lymphoid infiltration that is limited to the upper half of the cornea, then spreads to the center of the cornea (causing blindness from opacification of cornea overlying the pupil) and eventually the whole cornea. If treated early, pannus may resolve completely, but delay in treatment may cause permanent opacification.
Ophthalmia neonatorum is caused by C. trachomatis subtypes D through K. Ophthalmia neonatorum is a less severe infection than adult conjunctivitis (trachoma), but if not treated early it can cause superficial keratitis, otitis, and pneumonia in the neonate. Trachoma is caused by sterotypes A, B, and C.
The World Health Organization classifies trachoma using the FISTO mnemonic: follicular conjunctivitis; intense inflammation; scarring (due to tarsal conjunctival cicatrization with fibrous bands); trichiasis (with presence of at least one trichiatic eyelash caused by tarsal distortion and entropion [i.e., inversion of the eyelid margin]); and opacities in the cornea covering the papillary region.1
1. Sihota R, Tandon R. Parons' Diseases of the Eye. 19th edition. Oxford, England: Butterworth-Heinemann; 2003:185.
in reply: I want to thank Dr. Paturu for the timely information regarding chlamydial eye disease. In our article, we chose to address the most common causes of red eye in primary care in the United States. Although trachoma is an important manifestation of chlamydial eye infections internationally, with 6 million cases of blindness worldwide every year, the Centers for Disease Control and Prevention reports that blindness due to trachoma has been eliminated in the United States.1 We therefore did not include a discussion of trachoma in this article.
1. Centers for Disease Control and Prevention. Department of Health and Human Services. Trachoma. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/trachoma_t.htm. Accessed August 19, 2011.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: email@example.com, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2012 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions