Images in Emergency Medicine

Article Outline

• Diagnosis
  • Chlamydia conjunctivitis
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[Ann Emerg Med. 2007;49:823.]

A 14-day-old female infant presented to the emergency department with a unilateral eye discharge for 2 days. The eyes and lids had become more swollen throughout the past day. Although the discharge was initially watery, it was now copious and purulent (Figure 1). He was feeding well and was afebrile. There was no history of lethargy, irritability, or respiratory distress.

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• Figure 1. 

  An infant with right-sided copious and purulent eye discharge.

Vital signs were stable and the child was afebrile. Moderately hyperemic conjunctiva with thickened palpebral conjunctiva was noted. There were no corneal ulcerations. Pupils were equal, round, and reactive to light. Extraocular movements were intact. The remainder of the examination results was normal. Giemsa stain of conjunctival scraping revealed basophilic intracytoplasmic inclusion bodies within epithelial cells (Figure 2).

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• Figure 2. 

  A Giemsa stain showing intracytoplasmic inclusion bodies from epithelial cells of the conjunctiva. Used with permission of Barry Hahn, MD, Department of Emergency Medicine, Staten Island University Hospital, Staten Island, NY.

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Diagnosis 

Chlamydia conjunctivitis 

Chlamydia conjunctivitis infects roughly 50% of infants born vaginally to mothers infected with chlamydia and has been identified as the most common infectious cause of neonatal conjunctivitis. The incubation period is 5 to 14 days. Infants usually present with hyperemic conjunctiva, mucopurulent discharge, pseudomembrane formation, swollen eyelids, and chemosis. Diagnosis is made with Giemsa staining, which identifies intracytoplasmic inclusion bodies from the epithelial cells of the conjunctiva. Tissue culture, direct fluorescent antibody, polymerase chain reaction, or enzyme immunoassay is an alternative for diagnosis.

Topical therapy alone is insufficient, though hospitalization is not required. Erythromycin is adequate systemic therapy to treat ocular and other potential systemic infections. Neonates born to mothers with untreated chlamydia during delivery should be treated for 14 days. Because the efficacy of systemic erythromycin therapy is approximately 80%, a second course sometimes is required.