Overview
Chlamydial conjunctivitis, or pink eye, is an eye infection that usually occurs when infected genital secretions reach the eye, often through hand-to-eye spread during sexual exposure. Moreover, about 20-50% of newborns contract neonatal chlamydial conjunctivitis, which is transferred from the mother with cervical chlamydia during birth. As per a study published in the Journal of the American Medical Association, out of all acute conjunctivitis cases, 1.8-5.6% of infections are due to chlamydia in adults. It is a bacterial STI that is more common in young women.
What is chlamydial conjunctivitis?
It is a bacterial eye infection that causes inflammation and swelling of the eyelids and the white of the eye. This membrane is called the conjunctiva, and illness or inflammation of this membrane is called conjunctivitis. However, if the agent causing conjunctivitis is chlamydia, then it is called chlamydial conjunctivitis.
Chlamydia is an STD and can affect the eyes if the semen or genital fluid of the person suffering from the infection comes in contact with the eyes. Additionally, newborns can contract ocular chlamydia infection if the mother suffers from an illness while giving birth. It can be unilateral or bilateral, meaning it typically affects one eye but can also affect both eyes.
What Does Chlamydia in the Eye Look Like?
A chlamydial eye infection looks a lot like regular pink eye at first glance, but there are key differences if you know what to look for. The most common visual signs include:
- Pseudomembrane: In more severe cases, a thin membrane may develop over the white part of the eye.
- Redness: The white of the eye appears pink or bloodshot, caused by dilated blood vessels in the conjunctiva.
- Swollen eyelids: The upper and/or lower eyelids may appear puffy and inflamed.
- Discharge: A watery or mucous discharge that may crust along the lash line, especially after sleeping.
- Follicles: Small, raised bumps on the inner surface of the lower eyelid — a hallmark sign that helps distinguish chlamydial conjunctivitis from other types of pink eye.
In newborns, symptoms usually begin 5–12 days after birth. Other STD eye symptoms include swelling, pink eye, and bloody or watery chlamydia eye discharge. In some cases, a pseudomembrane develops that covers the whites of the eye. These STI symptoms take a while to appear post-delivery. However, they can occur sooner if the amniotic sac ruptures during delivery.
If the person has genital chlamydia and chlamydial conjunctivitis, which is likely in the case of adults, males, and females, they experience different symptoms.
- Females: Women experience pain while urinating, pain during sex, bleeding between periods or after sex, pelvic pain, and abnormal vaginal discharge.
- Males: In men, testicular pain, white or cloudy penile discharge, itch or burning sensation in the urethra, and pain while peeing are the common symptoms.
How do you get chlamydia in your eye?
Chlamydia is a contagious disease, which means it spreads from one person to another. Here are some common ways Chlamydia is transmitted:
Hand-to-Eye Contact
This is the most common route. If you touch infected genital secretions and then touch your eye, the bacteria can transfer directly to the conjunctiva. Studies show that 40 to 90 percent of adults with chlamydial conjunctivitis also have genital chlamydia, confirming that the eye infection almost always traces back to a genital source.
Direct Sexual Contact
Oral-genital contact or contact with a partner’s genital fluids during sexual activity can introduce Chlamydia trachomatis directly to the eye. The incubation period is 4 to 12 days, and most adults who develop chlamydial conjunctivitis have had a new sexual partner within the prior two months.
Sharing Personal Items
Sharing towels, washcloths, pillows, or eye cosmetics with someone who has the infection can spread the bacteria, although this route is less common. The bacterium cannot survive long outside the human body, so transmission through shared items requires recent contamination.
Contaminated Swimming Pools
In rare cases, inadequately chlorinated pools can serve as a transmission route.
Mother-to-Newborn Transmission
Newborns can contract chlamydial conjunctivitis as they pass through the birth canal of an infected mother. Research shows that 30 to 50 percent of infants born to mothers with chlamydia will develop neonatal conjunctivitis, typically within 5 to 14 days after delivery.
How do you test for chlamydia in the eye?
Your provider diagnoses a chlamydia infection by physically examining for symptoms or running diagnostic tests. Diagnostic tests are done using a swab from your eye conjunctiva, on which bacterial presence is tested. Other tests check for STDs like syphilis, chlamydia, gonorrhea, or HIV.
What antibiotics are used to treat chlamydia in the eye?
Chlamydia in the eye is usually treated with oral antibiotics, because the infection often affects more than just the eye. In adults, doctors commonly use Doxycycline or Azithromycin. However, treating yourself alone won’t help if your partner also suffers from this infection. Therefore, you should check for STI infections in your partner, and your doctor can prescribe a suitable antibiotic course for both you and your partner. It takes approximately 3 to 4 weeks for the antibiotics to eliminate the bacterial infection completely.
Newborn chlamydial conjunctivitis is usually treated with oral antibiotics, not just eye ointment. Topical treatment alone is not enough. CDC guidance recommends oral erythromycin base or ethylsuccinate, with close follow-up because a second course may sometimes be needed. If the infection is diagnosed early, chlamydia eye infection treatment can occur sooner. As in newborns, immunity is relatively low, and chlamydia can cause blindness if left untreated.
The following antibiotics are usually recommended for adults:
- Erythromycin: 500 mg four times daily for 7 days.
- Azithromycin: 1 g as a single dose
- Doxycycline: 100 mg twice daily for 7 days
Azithromycin is often preferred for its convenience, as a single dose clears the infection. Doxycycline is the standard first-line option when a full course is appropriate. Your doctor may also prescribe lubricating eye drops or ointment to manage symptoms like dryness and irritation during treatment.
What Happens If Chlamydia in the Eye Is Untreated?
Left untreated, chlamydial conjunctivitis may resolve on its own in 6 to 18 months. However, during that entire time, you can unknowingly spread the infection to sexual partners and, in the case of pregnancy, to your newborn.
Even if the infection eventually clears, waiting carries risks:
- Chronic inflammation: The infection can persist for months, causing ongoing redness, discharge, and discomfort.
- Corneal involvement: Subepithelial infiltrates and superficial vascularization can develop on the cornea, potentially affecting vision.
- Conjunctival scarring: Prolonged infection can scar the inner eyelid, though this is rare in developed countries with access to antibiotics.
Can Chlamydia in the Eye Cause Blindness?
Yes, but the risk depends on the type of infection. Adult inclusion conjunctivitis (caused by C. trachomatis serotypes D-K) rarely causes blindness when treated. However, trachoma (caused by serotypes A-C) is the leading infectious cause of blindness worldwide, responsible for visual impairment in approximately 1.9 million people. It’s important to treat the condition promptly to avoid complications.
How can I help prevent chlamydial conjunctivitis?
You can prevent chlamydial conjunctivitis by following certain practices and increasing hygienic measures:
- Avoid sharing personal care items, such as towels, pillows, washcloths, or sheets, with others. Even if one of your eyes has an infection, don’t use the same towel for both eyes.
- Frequently wash your hands, especially after intercourse, and don’t touch or rub your face or eyes with dirty hands.
- During intercourse, use latex or polyurethane condoms. Also, avoid sexual activity with multiple partners.
- Avoid sharing makeup products or eye cosmetics, especially if you or someone in your household has an infection. If you have had an eye infection, refrain from using the same makeup that you used during the infection.
- If the infection occurs during pregnancy, the mother should receive treatment before delivery to prevent the transmission of the disease to the newborn baby.
Consult a Doctor
If you had unprotected sex and see signs and symptoms of chlamydia infection, or have multiple sexual partners or a new sexual partner, consult your doctor immediately. Also, if you are pregnant and experience the symptoms of chlamydial conjunctivitis, visit your GP as soon as possible to get the appropriate treatment before the delivery of the baby.
FAQs About Chlamydia in Eye
Chlamydia in the eye occurs due to sexually transmitted chlamydia infection via hand-to-eye contact with sexual fluids or genitals. Therefore, it can spread from your partner or your genitals. Moreover, an infant can also contract chlamydia upon birth from an infected mother. Sharing personal care products with an infected person can also spread it.
The symptoms of chlamydia in the eye include watery discharge, redness, swelling, itching, and pus. These symptoms appear within 2 to 19 days of initial exposure.
It is extremely unlikely. Chlamydia trachomatis cannot survive for more than a few minutes outside the human body. For transmission to occur, infected genital fluids would need to contact your eye almost immediately. You are far more likely to pick up a fungal infection like athlete’s foot at the gym than a sexually transmitted infection.
Chlamydial conjunctivitis is a type of pink eye, but it behaves differently from the viral and bacterial forms.
Viral pink eye comes on suddenly, produces a watery discharge, and typically spreads from one eye to both. It’s highly contagious in households but resolves on its own within 1–2 weeks without antibiotics.
Bacterial pink eye also starts suddenly, but the discharge is thick and yellow-green. Eyelids often get stuck shut overnight. It clears up within 7–10 days with topical antibiotic drops.
Chlamydial conjunctivitis develops slowly over days to weeks, not overnight. It usually affects only one eye.
The discharge is watery to mucous, not thick pus, and it does not respond to standard topical eye drops.
