Information on Inclusion Conjunctivitis

Inclusion conjunctivitis in the newborn results from passage through an infected birth canal and develops 5-14 days after birth.

Inclusion conjunctivitis is a self-limited suppurative conjunctivitis, acquired by newborns as they transit the birth canal. It is caused by Chlamydia trachomatis.  This disease affects four of 1,000 (0.4%) live births. Approximately half of the child’s born to untreated infected mothers will develop the disease. Inclusion conjunctivitis is contracted as the child passes through the mother's cervix. Two-thirds of those females with a chlamydial infection pass the infection on to the child during childbirth.

Mutually eyelids and conjunctivae are swollen. There may be a ejection of pus from the eyes. Most instances of mature inclusion conjunctivitis effect from exposure to infected genital secretions. It is transmitted to the eye by fingers and occasionally by the water in swimming pools, poorly chlorinated hot tubs, or by sharing makeup. In adult inclusion conjunctivitis, one eye is usually involved, with a stringy discharge of mucus and pus. There may be little bumps called follicles inside the lower eyelid and the eye is red. Large follicles may be seen if the lower lid is pulled down.

The lymph nodes near the ears, called the preauricular nodes, may be swollen. Because the symptoms of chlamydia wax and wane and because the adolescent or adult may be asymptomatic, proper diagnosis may be delayed. Occasionally, the condition damages the cornea, causing cloudy areas and a growth of new blood vessels (neovascularization). Doxycycline, ocufloxacin, and erythromycin are sometimes prescribed. Oral tetracycline should not be administered to children whose permanent teeth have not erupted. It should also not be given to nursing or pregnant women and children under eight years of age.

Ocufloxacin is not given to those under 18 years of age. Topical antibiotics are not vital if total or oral medication is prescribed, but if there is a co-existing inflammation in the eye, then topical steroids may be given. Antibiotic eye drops only may not be enough to prevent inclusion conjunctivitis in the newborn if the mother is infected with chlamydia. The incidence of neonatal conjunctivitis can be reduced by applying erythromycin ointment to the newborn's eyes shortly after delivery. Silver nitrate, which may be instilled at some institutions at birth (instead of erythromycin), is not effective against chlamydia.

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