Chlamydial keratoconjunctivitis: Chlamydial or inclusion keratoconjunctivitis is characterized by a prominent follicular response with nontender preauricular lymphadenopathy Punctate epithelial keratitis is often noted superiorly and can evolve to marginal or subepithelial infiltrates. Micropannus can occur. Chlamydial infection causes one of the most common forms of neonatal conjunctivitis in the newborn it may be associated with chlamydial pneumonitis. Neonatal patients do not develop a follicular reaction, however, making diagnosis more difficult. Chlamydial infection commonly occurs in sexually active individuals and is usually found in conjunction with urethritis or cervicitis, although urogenital symptoms may not be present. Although oral treatment with tetracycline, doxycycline, erythromycin or azithromycin is the mainstay of therapy for chlamydial keratoconjunctivitis, topical tetracycline or erythromycin ointment once or twice daily can help to alleviate the ocular symptoms. 

Trachoma: Trachoma is caused by chronic and recurrent chlamydial infections. Although different serotypes of Chlamydia trachomatis are clearly important, types A-C are associated with trachoma, whereas types D-K are associated with inclusion conjunctivitis and genital infections. The acute stages of trachoma produce a follicular conjunctivitis and epithelial keratitis. These inflammatory components lead to conjunctival lead to conjunctival scarring and pannus formation. Conjunctival scarring can subsequently lead to a dry eye, Trichiasis, and entropion.

Herbert’s pits are small depressions at the limbus that represent areas of slight thinning at the site of necrotic follicles. Eyelid and eyelash changes can cause progressive corneal erosion and scarring that can predispose to bacterial keratitis. The active infectious stage of trachoma is treated with systemic antichlamydial therapy. Surgical correction is sometimes needed for the secondary eyelid and corneal complications. For the treatment of trachoma, topical sulfacetamid, tetracycline or erythromycin is recommended alongwith oral tetracycline or erythromycin.