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Am Fam Physician. 2012;85(1):6

Original Article: Diagnosis and Management of Red Eye in Primary Care

Issue Date: January 15, 2010

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

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.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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