Chlamydia in the Eye: Symptoms, Causes & Treatments

Chlamydia is a sexually transmitted infection (STI) that develops from the spread of the bacteria, Chlamydia trachomatis. It is one of the most common STIs in the United States, and it can affect the eye. 

How Do Medical Experts Define Chlamydia?

The Journal of Indian Ophthalmology defines Chlamydia trachomatis as a bacterium of the eye that causes trachoma and neonatal and adult conjunctivitis. The bacterium has been the leading cause of blindness during the last century worldwide.

While chlamydia itself is frequently associated with genital infections, it may also emerge in the throat, rectum, and eye. 

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Trachoma

The World Health Organization (WHO) states that trachoma is an international health problem. The ocular disease and infection are currently prevalent in 42 countries, accounting for the visual impairment of almost 2 million people worldwide. 

Blindness resulting from trachoma is permanent but also preventable.

Causes of Trachoma

Trachoma is caused by the chlamydia trachomatis bacteria.

WHO adds that the infection spreads by personal contact, whether it originates from hands, bedding, clothing, or hard surfaces. Flies may also spread discharge from the nose or eyes of an infected person.

Over time, the infection can trigger the lashes to draw inward. The hairs, in response, may rub the eye’s surface, causing both pain and lasting corneal damage.

Symptoms

The American Academy of Ophthalmology (AAO) states that severe trachoma symptoms present themselves as follows:

• Inner upper eyelid scarring
• New growth of blood vessels in the cornea
• Inward-turned eyelashes

At the onset of the infection, the patient often experiences blurriness, itchiness, redness, pus, or a watery discharge. These symptoms are associated with pink eye or conjunctivitis. 

Treatment of Trachoma

Treatment includes the administration of antibiotics in less severe cases. If the lashes have turned inward, surgery is usually recommended to correct the problem.

In 2021, surgery was performed on 69,266 individuals in advanced stages of the disease with close to 65 million people given antibiotic treatment. This equates to the dispensing of antibiotics at a level of 44 percent.

Adult Inclusion Conjunctivitis

Adult inclusion conjunctivitis (AIC) is defined as Chlamydia conjunctivitis. The sexually transmitted disease commonly occurs in young and active adults. 

This is the infection usually referenced as chlamydia in the eye. 

About one out of every 300 patients who contract genital chlamydial disease develop chlamydia in the eye, represented by adult inclusion conjunctivitis (AIC).

Cause of Adult Inclusion Conjunctivitis

The infection is normally transmitted by hand-to-eye contact spread from infected genital secretions.

Symptoms

Patients often complain that their eyes are irritated and red, and their vision is blurred. Discharge is another symptom. 

While the infection can occur at any age, it is most often seen in people 16 to 34 years old. However, neonates or elderly people are not immune either. 

In contact lens wearers, the disease may be erroneously attributed to the wearing of the lenses.

Chlamydia trachomatis is often defined as a silent epidemic because of the few symptoms it presents. In some people, it may lie dormant for months or possibly years.

Therefore, the typical symptoms of a chlamydial eye infection develop slowly and emerge in the form of any one of the following:

• Redness
• Itchiness
• Pus
• Water eye discharges (tears)
• Eyelid crusting
• Sensitivity to light

What is tricky about chlamydia in the eye is that it usually does not cause visual disturbances or pain in the eye it affects. The only way to know if you have the disease is to schedule an eye exam and do so on a regular basis.

General Causes 

Chlamydial conjunctivitis is usually transmitted sexually. Again, this happens when the patient’s eyes come into contact with an infected individual’s genital or urinary fluids. Therefore, the disease may spread in the following ways:

• Sharing a towel or bedding with an infected person
• Touching your eye, after sex, with unwashed hands
• Sharing makeup or cosmetics, such as false eyelashes or mascara with someone who is infected
• Giving birth, if the mother has an active infection

What Happens During an Exam

Your ophthalmologist will take a swab of your conjunctiva and send the sample to a lab to be tested. 

The conjunctiva of the eye lines the inside of the eyelid, shielding the sclera (the white area of the eye that covers the eyeball). It serves to lubricate the eye through the production of tears and mucus. It also prevents the entry of microbes into the eye, or microorganisms that cause ocular diseases.

After your eye exam, your doctor may recommend you schedule additional tests for STIs, such as syphilis or gonorrhea, which may also cause eye infections.

Prognosis of AIC

Chlamydia in the eye is normally treated with topical antibiotics. These medicines may take the form of ointments or eye drops. 

The infection usually clears up after several weeks, provided the doctor’s instructions are followed.

If you are diagnosed with chlamydia in the eye, your sexual partners should also receive treatment to prevent further spread of the disease.

Why Treating the Disease Is Important

If chlamydia in the eye goes untreated, it can lead to further vision complications that could have been easily prevented. 

Moreover, chlamydia conjunctivitis is usually not considered severe and can be treated easily, provided it is diagnosed early. If it is not diagnosed or treated, serious vision problems may develop, including loss of sight.

Diagnosis

Many cases of AIC go undiagnosed because it is caused by a sexually transmitted bacterium. Moreover, AIC is one of the most frequent reasons for recurring conjunctivitis.

About 54 percent of men and almost 75 percent of females who have AIC also have a concomitant urogenital chlamydial infection. 

Treatment for Chlamydia in the Eye

The disease is typically treated using topical antibiotics. 

Neonatal Conjunctivitis

The Centers for Disease Control and Prevention (CDC) highlights that neonatal conjunctivitis, originating from chlamydia, can be serious. Newborns with the disease exhibit pink eye shortly after delivery. 

Symptoms of Neonatal Conjunctivitis

Newly born infants with neonatal conjunctivitis develop pus within days or weeks after birth. The eyelids become tender, red, and swollen. 

Mothers with the sexually transmitted infection, chlamydia, often pass the bacteria to their newborn during delivery. Even if the mother is asymptomatic (without symptoms), she can still transmit the virus to her baby during vaginal delivery.

Chlamydia of the eye or conjunctivitis in a newborn may include the following symptoms:

• Watery discharge
• Redness
• Puffiness

The above symptoms show up about 7 days after birth.

Treatment for Newborn Conjunctivitis

Antibiotics are dispensed to the baby after diagnosis. This may take the form of IV administration or with an ointment.

Why Treatment Is Important

If newborns are not immediately treated, they may suffer from breathing problems (due to a lung infection) or blindness.

Important Facts to Note

Chlamydia trachomatis can cause both inclusion conjunctivitis and genital infections (chlamydia) if a woman does not receive treatment for the disease. 

Besides the eyes, infants may experience the infection in the back of the nose (nasopharynx) or the lungs.

Statistics show that about 30 to 50 percent of newborns born to mothers with active infections contract chlamydia in the eye during delivery.

How Trachoma Is Different From Conjunctivitis

Trachoma infects the inside of the eyelid and scars it. This causes the lashes to brush against the cornea, destroying the tissue. This friction can lead to permanent blindness.

Conjunctivitis may not present symptoms. When it does, it may present itself in the form of itchiness, redness, or watery eyes. These symptoms may be confused with other eye irritations or infections.

According to AAO, trachoma is typically seen in impoverished regions, while inclusion conjunctivitis in adults and infants happens in developed locations. However, trachoma may start out with symptoms of pink eye or conjunctivitis.

Disease Prevention

Chlamydia conjunctivitis is usually not considered severe and can be treated easily, provided it is diagnosed early. If it is not diagnosed or treated, serious vision problems may develop over time, including loss of sight

That is why proper hygiene and safe sex are critical in preventing chlamydia in the eye. A pregnant woman with chlamydia should receive treatment before giving birth. This will prevent the spread of the disease to her baby.

You should also make it a habit to have your eyes checked annually. This ensures any infections can be detected early before substantial damage takes place. If you notice anything out of the ordinary with your eyes, see an eye doctor promptly.

References

1. Chlamydial Eye Infections: Current Perspectives. (February 2017). National Center for Biotechnology Information.

2. Trachoma: Key Facts. (March 2022). World Health Organization.

3. Conjunctivitis (Pink Eye): Symptoms. (January 2019). Centers for Disease Control and Prevention.

4. Adult Inclusion Conjunctivitis Diagnosed by Polymerase Chain Reaction and Giemsa Stain. (December 2021). ID Cases, National Center for Biotechnology Information.

5. Take Chlamydia Seriously. (January 2018). Review of Optometry.

6. Conjunctivitis (Pink Eye) in Newborns. (January 2019). Centers for Disease Control and Prevention.

7. The Natural History of Chlamydia Trachomatis Infection in Women: A Multi-Parameter Evidence Synthesis. (March 2016). National Center for Biotechnology Information.

8. Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-Analysis. (August 2018). Journal of Pediatric Diseases Society.

9. What Is Trachoma? (February 2022). American Academy of Ophthalmology.

10. Study of the Prevalence and Association of Ocular Chlamydial Conjunctivitis in Women With Genital Infection by Chlamydia Trachomatis, Mycoplasma Genitalium and Candida Albicans Attending Outpatient Clinic. (August 2016). International Journal of Ophthalmology.