treatment plan
AIC: A Serious Public Health Concern
BY WILLIAM MILLER OD,PHD, FAAO

Adult Inclusion Conjunctivitis (AIC) is a less frequent, but more insidious, cause of conjunctivitis that includes Chlamydia trachomatis. Specifically, serotypes D-K are responsible for AIC, which displays a characteristic follicular conjunctivitis often confused with more common causes of conjunctivitis such as viral or solution toxicity. AIC can masquerade as other etiologic vectors for conjunctivitis, which can delay proper treatment.

Not only is AIC an ophthalmic dilemma, but it's also a highly contagious sexually transmitted disease and is therefore a serious public health concern.

Counsel patients and their partners about the ocular concern and also the urogenital issues that require consultative treatment with the patient's family practice, internal medicine or gynecologic practitioner.

AIC spreads to the ocular surface via venereal or hand-to-eye contact. The incubation period ranges from a few days to nearly three weeks. It's the number-one cause of neonatal conjunctivitis, according to the Centers for Disease Control (CDC).

Figure 1. A characteristic follicular conjunctivitis.

Investigating the Symptoms

Ocular symptoms are often bilateral, presenting as a follicular conjunctivitis with a marked hyperemic conjunctiva, papillary hypertrophy and a mucopurulent discharge. The conjunctivitis can be chronic. Corneal involvement can mimic that seen in Epidemic Keratoconjunctivitis (EKC) with infiltrates, superficial punctate keratitis and limbal swelling and superior limbal pannus. AIC can occur in contact lens wearers, and some practitioners misdiagnose it as a contact lens-related red eye.

The chronic nature of any conjunctivitis (despite ophthalmic therapy) necessitates investigating the patient's systemic health history, especially queries related to sexual and urogenital health.

A careful general health review may also uncover a tender, enlarged preauricular lymph node. Men may have symptomatic or nonsymptomatic urethritis while women may have vaginal discharge secondary to a chronic cervicitis. Often occurring in patients in their teens or 20s, a study by Katusic et al (2003) reported an average age of early 40s for AIC patients.

You can confirm a diagnosis with tests such as culturing or antigen detection using polymerase chain reaction tests.

Managing the Patient

Common treatment involves oral azithromycin (Zithromax) or doxycycline. Doxycycline treatment involves taking 100mg b.i.d. for at least one week. Zithromax is given as a single, one-gram dose and is often preferred. However, some may need more treatment even with Zithromax..Other oral antibiotics are prescribed less commonly because of increased risk of side effects.

The Katusic study demonstrated equal efficacy between doxycycline (100mg b.i.d. for 10 days) and Zithromax (single, one-gram dose) with an eradication of Chlamydia in more than 90 percent of patients and a clinical cure rate (disappearance of signs and symptoms) in 60 percent of the doxycycline group and 69 percent of the Zithromax group.

Primary care physicians must examine affected partners and treat them within 30 days, regardless of ocular status. Schedule a follow-up examination in your office one week after you initiate therapy.

Dr. Miller is on the faculty at the University of Houston College of Optometry. He is a member of the American Optometric Association and serves on its Journal Review Board. You can reach him at wmiller@uh.edu.