Ophthalmology

Chlamydial infection of the eye

What is a chlamydial infection of the eye?

Chlamydia are a specific type of bacteria that live and multiply inside cells of the body.
A distinction is made between several types that affect different organs:

The subspecies Chalmydia trachomatis, which is important here, affects the eye and the genital area, for example.
A chlamydial infection of the eye usually leads to conjunctivitis, which initially manifests itself through the corresponding symptoms (redness, itching, burning, photophobia - more on this below) and, if left untreated, can result in loss of vision.

causes

As mentioned above, the cause of this type of eye infection is the bacterium Chlamydia trachomatis.
Specifically, there are some subtypes of it, which we will not go into further here.

These chlamydia preferentially colonize mucous membranes, especially those in the genital and urinary tract, but also the mucous membrane of the eye.
Inadequate hygiene can often be considered as the cause of a chlamydial infection in the eye, and not necessarily by the person concerned:

Even people with whom the person concerned has had intensive and intimate physical contact can transmit chlamydia through inadequate hygiene and thus cause an infection.

Transmission path

As already indicated in the previous section, the most common transmission of chlamydia from person to person.

In many tropical areas there is also direct transmission of flies to humans, making chlamydial infection one of the most common causes of blindness in these areas.
In Europe, however, this type of transmission is negligible.

The transmission path from person to person is usually favored by a lack of hygiene or intimate contact:
It is noteworthy that a chlamydial infection of the urinary or genital area is very often not even noticed by the person concerned.
This can lead to the unintentional transfer of bacteria from the genital area to the mucous membrane of the eyes.

However, transmission can also take place in places where many people are present at the same time:
These include swimming pools and saunas, for example.

Please also read the article: Swimming pool conjunctitis

How contagious is that?

Chlamydia is transmitted very easily and quickly.
Even a single contact with chlamydia can result in an infection.

Since chlamydial infections in the urinary or genital tract often remain symptom-free and therefore go unnoticed, it is difficult to determine an exact number of the bacteria necessary for an infection. At the same time, however, this is a factor that must of course be taken into account when considering the risk of infection:
Infection or transmission can also occur if the person transmitting the disease has no symptoms or even does not even know about their own infection.

diagnosis

To diagnose a chlamydial infection, regardless of the location, the bacteria should always be detected from cell material in the affected region.

A smear can therefore be taken on the eye, which is then sent to a laboratory.
This is where the detection takes place, which is difficult compared to other bacteria:
The reason for this is that the chlamydia are almost exclusively in the body cells.

A proof or result from the laboratory can therefore take up to 14 days.
In some cases, therapy should therefore be started even before the diagnostic result is obtained.

Find out more about the topic at: Chlamydia test

These are the symptoms I can tell if I have a chlamydial infection in the eye

Depending on the subgroup of the causative chlamydia, a chlamydial infection in the eye manifests itself through different symptoms.
Common to all subgroups, however, is conjunctivitis, which will be discussed further below.

In the case of chlamydia, which is far more common in Europe, small raised areas appear on the inside of the upper and lower eyelids, which are often reddened on the outside or interspersed with veins.
Medically, these abnormalities are referred to as “conjunctival follicles”, which are caused by the activation and accumulation of immune cells at this point.

Chlamydia, which is less common in Europe but more common in tropical regions, causes more severe inflammation on the inner side of the eyelids, i.e. on the mucous membranes. If the infection has persisted for a long time, then scarring of the mucous membranes occurs.
This creates a “sticking” of tissues, which explains the restricted movement of the eye.
Due to the involvement of the cornea of the eye, the scarring and sticking of the mucous membrane can spread to the eyeball, which in extreme cases can lead to a loss of function of the eye (more on this in the section "Blindness").

These articles might also interest you:

You can recognize a chlamydial infection in men by these symptoms
Symptoms of chlamydial infection in women

Identify the infection by the conjunctivitis

Conjunctivitis (medical "conjunctivitis") is the most common symptom that triggers a chlamydial infection.

This leads to a reddened and watery eye.
The affected people usually experience itching or burning sensation in their eyes and can hardly bear light.
Often a feeling of a foreign body is also described, ie the feeling of "having something in mind".

Conjunctivitis can be caused by many different types of pathogens, and in fact viruses are a far more common cause of conjunctivitis.
It is therefore important to identify the cause in each case and to select the drug treatment accordingly.

Find out more about this at: Treatment of conjunctivitis

therapy

Chlamydia are bacteria that reside almost exclusively inside body cells.
In order to treat a chlamydial infection, antibiotics are necessary, which have proven to be particularly effective against these “intracellular” bacteria.

Please also read our detailed article on this: Antibiotic therapy for chlamydia

These antibiotics are then usually applied both locally to the eye and to the whole body.
In order to prevent further, progressive inflammation and the resulting scarring, anti-inflammatory drugs are also often used.
For this purpose, the glucocorticoids (such as cortisone) have proven particularly useful in ophthalmology. This combination of antibiotics and glucocorticoids is often used for eye infections, but very rarely used in other medical specialties.

Since chlamydia is a disease that is also sexually transmitted, any infection with this bacterium must also be treated for the partner of the person affected.
Otherwise there can be mutual re-infection, since one of the two people is always infected (possibly symptom-free).

Feel free to read our detailed article on the subject: Treatment of a chlamydial infection

Course of disease

An infection with chlamydia begins - similar to other infectious diseases - initially with an incubation period.
This is the time it takes for a pathogen to multiply in the body to such an extent that symptoms can be triggered.
This time can last one or more weeks.

In the case of an infection of the eye, the acute infection begins afterwards, during which the symptoms described above appear.
If the infection is not treated, it can become chronic or scarring with loss of function of the affected eye.

In contrast, the healing options under antibiotic therapy are excellent:
With the use of these drugs, the infection can be completely eliminated.

Existing scarring can, however, be irreversible, i.e. permanent.

What can the long-term consequences be?

Untreated chlamydial infections of the eye can cause serious damage due to the persistent inflammation:

In the event of an inflammatory reaction, tissue destruction occurs, which in turn causes scarring.
This scarring also leads to a restriction or even to a loss of the actual function of the tissue.
In the case of an eye infection by chlamydia, in the worst case scenario, blindness can be a consequence.

But the infection can also become chronic without going blind:
This is understood to mean the long-term persistence of the symptoms and the associated poorer response to medication.

Find out how you can alleviate the symptoms at: Home remedies for conjunctivitis

Blindness

Loss of vision due to a chlamydial infection is possible, but very rare, especially in Europe and other countries with good hygienic conditions.

Because not all subgroups of chlamydia cause the process of scarring, which, as described above, can lead to blindness in the long term:
The subgroups (“serovars”), which often occur in countries with good hygienic conditions, do not trigger this process.

Caution is therefore more advisable in countries that do not meet the hygienic standards of industrialized countries, as well as in countries with a tropical climate.
Infection with the more dangerous types of chlamydia, which in the long term can lead to blindness, can certainly occur here.

forecast

An acute infection with chlamydia of the eye should always be treated with medication, as it otherwise entails serious risks such as chronification or even blindness.

Antibiotic therapy usually lasts between one and three weeks.
If the person is in a partnership, any existing infection in the partner should also be treated, as chlamydia is a disease that can be transmitted through body contact and smear infections.

After the therapy has been completed, however, the infection can be assumed to have completely healed.
There is no increased risk of re-infection if the hygienic instructions are observed.