Chlamydial conjunctivitis – infectious defeat mucous an eye hlamidiya, followed by an acute or chronic inflammation of a conjunctiva. Chlamydial conjunctivitis proceeds with hypostasis of a conjunctiva and transitional folds, purulent separated from eyes, dacryagogue, gripes in eyes, follicular rashes on a lower eyelid, a parotid adenopatiya, the phenomena of an evstakhiit. Diagnosis of chlamydial conjunctivitis consists in carrying out biomicroscopy, cytologic, cultural, immunofermental, immunofluorescent, PTsR-of researches for definition of hlamidiya. Treatment of chlamydial conjunctivitis is carried out by means of antibiotics of a tetracycline row, macroleads and ftorkhinolon before absolute clinical laboratory recovery.
Chlamydial conjunctivitis (, clamidiosis of eyes) makes 3-30% of number of conjunctivitis of various etiology. Clamidiosis of eyes meets at persons at the age of 20-30 years more often, at the same time women get sick with chlamydial conjunctivitis by 2 – 3 times more often than men. Chlamydial conjunctivitis arises, mainly, against the background of urogenital clamidiosis (an uretrit, a colpitis, a tservitsit) which can proceed in the erased form and not disturb the patient. Therefore chlamydial infections fall within the scope of attention of ophthalmology, venereology, urology, gynecology.
Reasons of chlamydial conjunctivitis
Chlamydial conjunctivitis is caused by the intracellular microorganism of Chlamydia trachomatis showing properties of bacteria and viruses. Forming so-called L-forms, hlamidiya are capable to long parasitizing in cages in the inactive, "sleeping" state. Under different adverse conditions (reception of antibiotics, overcooling, a SARS, overheating), in the period of immunosupression, there is "awakening" (reversion) of hlamidiya from L-forms and active reproduction to development of clinical symptomatology.
Different anti-gene serotypes of a hlamidiya cause various damages: so, serotypes of A, B, Ba and C lead to development of trachoma; serotypes of D - K – to developing of paratrachoma of adults, epidemic chlamydial conjunctivitis, urogenital clamidiosis; L1-L3 serotypes – to development of an inguinal limfogranulematoz.
In most cases chlamydial conjunctivitis arises against the background of clamidiosis of an urinogenital path: statistically, about 50% of patients with oftalmokhlamidiozy infections have also urogenital form. At adults eye clamidiosis develops as a result of an activator drift in a conjunctival bag from genitals through the sanitary products and hands polluted by allocations. At the same time the carrier of urinogenital clamidiosis can infect not only the organ of vision, but also eyes of the healthy partner. Quite often chlamydial conjunctivitis is a consequence of oral and genital sexual contacts with the infected partner.
Cases of professional infection with chlamydial conjunctivitis among obstetricians-gynecologists, venereologists, urologists-andrologists, ophthalmologists examining patients with various forms of clamidiosis are known. Infection with chlamydial conjunctivitis is possible through water at visit of public pools and baths. Such form of a disease received the name of "basin" or "bathing" conjunctivitis and often can accept the nature of epidemic flashes.
Chlamydial conjunctivitis can accompany the course of an autoimmune disease - a syndrome of Reuters, however the pathogenesis of an oftalmokhlamidioz at this pathology is up to the end not studied.
Chlamydial conjunctivitis at newborns can develop owing to pre-natal (transplacentary) infection or infection of eyes at the time of delivery from the patient with clamidiosis of mother. The chlamydial eye infection occurs at 5-10% of newborns.
Thus, sexually active men and women have the increased risk of development of chlamydial conjunctivitis; patients with clamidiosis of an urogenital path; members of families (including children) where there are patients with sexual or eye clamidiosis; medical experts; the persons visiting public baths, saunas, pools; the children born from mothers having clamidiosis.
Classification of forms of chlamydial conjunctivitis
Chlamydial defeat of a conjunctiva of eyes can proceed in shape:
- Chlamydial conjunctivitis of adults (paratrachoma)
- Chlamydial conjunctivitis of newborns (blennorea)
- Basin conjunctivitis
- Epidemic chlamydial conjunctivitis of children
- Chlamydial conjunctivitis at a syndrome of Reuters
- Chlamydial conjunctivitis (meybomit) of the zoonozny nature.
Besides, in ophthalmology allocate also other forms of an oftalmokhlamidioz: chlamydial keratit, chlamydial uveit, chlamydial episklerit, etc.
Symptoms of chlamydial conjunctivitis
Clinical displays of chlamydial conjunctivitis develop after the incubatory period (5-14 days). As a rule, one eye is surprised in the beginning, bilateral infection occurs at 30% of patients. In 65% of cases chlamydial conjunctivitis proceeds in the form of a sharp or subsharp eye infection, in other cases - in chronic option.
At a chronic current slow, often recidivous blefarita or conjunctivitis with moderately expressed symptomatology are noted: insignificant hypostasis a century and conjunctiva fabric hyperaemia, mucous allocations from eyes.
Sharp chlamydial conjunctivitis and aggravation of chronic forms is followed by the expressed puffiness and infiltration mucous an eye and transitional folds, a photophobia and dacryagogue, gripes in eyes, plentiful office of the mucopurulent or purulent secret which is sticking together eyelids from eyes. Patognomonichno development on the party of defeat of a painless regional preear adenopatiya, and also the evstakheit which is characterized by pain and noise in an ear, decrease in hearing.
At visual survey of eyes on a conjunctiva multiple follicles, gentle fibrinozny films which, as a rule, resolve without scarring are defined. The sharp phase of chlamydial conjunctivitis lasts from 2 weeks to 3 months.
At newborns and children of early age, except pronounced eye symptomatology, chlamydial pneumonia quite often develops, nazofaringit, rhinitis, sharp otitis, evstakhiit. Complications in the form of a stenosis of plaintive and nasal ways, scarrings of a conjunctiva are frequent.
Diagnosis of chlamydial conjunctivitis
Diagnostic tactics at suspicion of chlamydial conjunctivitis provides carrying out ophthalmologic inspection, laboratory analyses, consultations of adjacent experts (the venereologist, the gynecologist, the urologist, the rheumatologist, the otolaryngologist).
The eye biomicroscopy with use of a slot-hole lamp reveals characteristic hypostasis, infiltration and a vaskulyarization of a limb. For an exception of defeat of a cornea instillyatsionny flyuorestseinovy test is carried out. For the purpose of assessment of a condition of a retina and a uvealny path the oftalmoskopiya is used.
The leading role in confirmation of the diagnosis of chlamydial conjunctivitis belongs to laboratory researches. The combination of various methods of allocation of hlamidiya in scrape from a conjunctiva (cytologic, immunofluorescent, cultural, PTsR) and antibodies in blood (IFA) is optimum. If necessary to patients inspection is appointed to urogenital clamidiosis.
Clamidiosis of eyes needs to be differentiated from bacterial and adenoviral conjunctivitis.
Treatment of chlamydial conjunctivitis
Medicines of etiotropny action at chlamydial conjunctivitis are antibiotics: ftorkhinolona, macroleads, tetratsiklina. Local therapy includes instillations of antibacterial eye drops (solution of an ofloksatsin, ciprofloxacin solution), mazevy applications for eyelids (tetracycline ointment, eritromitsinovy ointment), application of anti-inflammatory drops (indometacin solution, dexamethasone solution).
System treatment of clamidiosis is carried out according to the scheme of therapy of STD. Serve as criteria of an izlechennost of chlamydial conjunctivitis: regression of clinical symptomatology, negative data of the laboratory tests which are carried out in 2-4 weeks after the termination of a course of treatment and three subsequent analyses taken at an interval of one month.
Forecast and prevention of chlamydial conjunctivitis
Consequences of the postponed chlamydial conjunctivitis can be various. At rational therapy the disease, as a rule, comes to the end with an absolute recovery. Quite often chlamydial conjunctivitis gets a recidivous current.
The scarring of a conjunctiva and cornea of eyes leading to decrease in sight can be an outcome of recidivous forms of an oftalmokhlamidioz.
Prevention of chlamydial conjunctivitis demands timely detection and treatment of urogenital clamidiosis from adults (including pregnant women), uses of individual sanitary products in a family, protection of eyes points when swimming in the pool, using means of protection by medical personnel.