Swimming pool conjunctivitis


Classic swimming pool conjunctivitis takes its name from the infection that used to be common in swimming pools. In the meantime, the infection rates in swimming pools with good hygienic conditions are extremely rare, which is why the term is no longer entirely up to date.

Swimming pool conjunctivitis is an infectious inflammation of the conjunctiva caused by bacteria. It is also known as paratrachoma, or inclusion body conjunctivitis when it occurs in newborns. If the bacterium adheres to the conjunctiva, it can lead to inflammation, which manifests itself in reddening, burning and itching of the eye and occasionally pus formation. Because the cause of the disease is bacterial, antibiotic eye drops can be used for treatment. As a rule, swimming pool conjunctivitis heals without any consequences after a few days.

Treatment of swimming pool conjunctivitis

Treatment of conjunctivitis can initially be purely symptomatic. Eye drops that regularly wet the eye are used. They can reduce the itchiness and stinging of the eyes and so relieve the discomfort. If the symptoms do not improve within a few days with the eye drops alone, an infectious cause of the conjunctivitis must be assumed. A smear should be taken that can examine the underlying pathogen.

Read more on the subject at: Treatment of conjunctivitis

If it turns out that it is an infection with chlamydia, i.e. swimming pool conjunctivitis, antibiotic therapy should be given. Since chlamydia are bacteria that like to hide in human cells, therapy should be carried out with antibiotic eye drops as well as with systemic therapy (e.g. tablets). Antibiotics from the group of macrolides can be used for this purpose. Erythromycin and azithromycin are popular for systemic therapy, and there are also erythromycin eye drops that attack the bacteria directly in the eye.
It is also important to adhere to strict hygienic rules: You should not rub your eyes and wash your hands frequently so that the pathogens cannot be passed on to other people.

Additional treatment by the partner is required during treatment. The partner does not necessarily have to have symptoms, but can also be the silent carrier of the pathogen. The affected patient can then unknowingly become infected again after the therapy, which is known as the ping-pong effect. Therefore, the partner should definitely be treated as well.

Read more on the subject at: Eye drops containing antibiotics

Duration of pool conjunctivitis

If the diagnosis is late or the therapy is inadequate, the symptoms can drag on for weeks to months. In addition, the risk of infection is very high, so that people in the immediate vicinity can also be infected quickly. Adequate hand hygiene should always be observed and hand-eye contact should be avoided.
With good treatment, swimming pool conjunctivitis usually heals within a few days to a week without further complications or consequences.

Accompanying symptoms of swimming pool conjunctivitis

The typical symptoms of swimming pool conjunctivitis are initially the same as those that occur with normal conjunctivitis.
The disease begins about 4-14 days after infection - usually with reddening and swelling of the eye. In most cases, only one eye is affected at first. Often there is also a strong sensation of foreign bodies, which is accompanied by severe itching.
In addition, there is often a stronger flow of tears in the context of swimming pool conjunctivitis, usually accompanied by a purulent-slimy accumulation of fluid. The formation of pus can cause the eyes to stick to the eyelashes, especially at night when they are closed for a long time. It is not uncommon for swimming pool conjunctivitis to cause pain in the eyes.

In severe cases, photophobia and visual impairment can occur, as the symptoms worsen in strong light.
In the course of the disease, follicles form on the conjunctiva in the area of ​​the eyelids, which are often gray-red and grain-shaped, and lead to swelling of the lymph nodes around the eye.

In the case of swimming pool conjunctivitis, the eyes should be rubbed as little as possible, as otherwise the bacteria can be transferred to the hands and there is an increased risk of infection for other people. Without treatment, both eyes can be affected over time and the symptoms can last for weeks to months.

Please also read our detailed article on the subject:

  • Chlamydia infection in the eye
  • How to recognize conjunctivitis

How contagious is swimming pool conjunctivitis?

How contagious swimming pool conjunctivitis is also depends on the route of infection. In this way, the chlamydia can be transmitted directly from person to person, but infection through liquids and dirty surfaces is also possible.
With direct transmission, the risk of infection is very high. If there is a transmission through liquids, the risk of infection depends on how many bacteria are in the liquid. The greatest risk of infection is therefore with direct transmission, for example during sexual intercourse or subsequently through contact with hands and eyes contaminated with bacteria. Strict hand hygiene should be observed to avoid infection and each person should use their own towels.
If there is a known infection of the genital area, sexual intercourse should only take place with condoms, so that a general risk of infection can be minimized.

Read more on the subject at: Is conjunctivitis contagious?

Diagnosis of swimming pool conjunctivitis

In most cases, a good interview and physical examination are sufficient to diagnose swimming pool conjunctivitis.
The reddened eyes are classic. In the questioning of the person concerned (anamnesis), a one-sided beginning, which then spreads to both eyes, is usually reported. The typical symptoms with a suitable medical history quickly suggest inflammation of the conjunctiva.

To confirm the diagnosis of conjunctivitis, a slit lamp examination can be performed, which reveals swelling and fluid retention in the conjunctiva.

In order to clarify the diagnosis of swimming pool conjunctivitis, a swab must also be taken from the affected eye. The pathogen (Chlamydia trachomatis) can be detected from the smear in a bacterial culture or a PCR test. However, chlamydia is not that easy to grow. In addition, so-called inclusion bodies can stand out. These are bacteria trapped in the cell, which is a classic criterion for infection with chlamydia.

Causes of pool conjunctivitis

The cause of swimming pool conjunctivitis is an infection of the conjunctiva in the eye (conjunctiva), usually with the bacterium Chlamydia trachomatis. The conjunctiva in the eye is often initially irritated, for example due to an allergic reaction or a foreign body in the eye. This weakens the defense barriers and the bacterium can more easily establish itself in the conjunctiva.

In the past, chlamydia was often transmitted via the water in swimming pools, but with the good hygienic conditions that have now prevailed, infections in the "western" world have decreased significantly. The classic route of infection with the bacterium Chlamydia trachomatis now consists in the transmission of the bacterium, which also occurs in the genital area, via the hands to the eyes. In newborns, transmission from the mother's genital area can also occur during birth.

Read more on this topic at: Infection of the eye

Infection with the bacterium Chlamydia trachomatis

The bacterial species Chlamydia trachomatis belongs to the chlamydia family. A distinction is made between different types of Chlamydia: There are Chlamydia pneumoniae and psittaci, which are transmitted through the air and therefore mainly cause diseases of the lungs and the respiratory tract.

The subspecies Chlamydia trachomatis mainly settles in the genital area and in the eyes. With the trachomatis chlamydia, a distinction is made between different subspecies, the so-called serotypes. The serotypes D-K are known to be the trigger for swimming pool conjunctivitis.

There are two different ways of transmission. In countries with poor hygienic conditions, swimming pool use can lead to infection. If the basins are not adequately disinfected, pathogens can spread from other affected people to other people.
In western countries, however, swimming pools are adequately disinfected. In these, however, an eye infection can occur in patients with a sexually transmitted disease caused by chlamydia. If hand hygiene is poor, the pathogens can get into the eye if it itches and lead to an infection.

Please also read our detailed article on the subject: Chlamydia infection in the eye

Infection with the adenovirus

In rarer cases, swimming pool conjunctivitis can be caused by viruses, adenoviruses in particular. This form of infection is also known as follicular conjunctivitis or epidemic keratoconjunctivitis.It is very contagious and is usually transmitted through smear infection with poor hand hygiene or through infected water, for example in swimming pools.

It leads to severe itching of the eyes and a foreign body sensation. In addition, pus can form. Itching of the eyes usually leads to severe redness and impaired vision. The eye is rinsed intensively for treatment.

How long is the incubation period?

The incubation period describes the time from infection with the pathogen to the onset of the disease. Since swimming pool conjunctivitis can be transmitted through different routes, the incubation period varies somewhat. It is usually between 4 and 14 days.

If the pathogen gets directly into the eye, for example by rubbing the eyes with infected hands or through direct contact of the eye with contaminated water, the incubation time is usually shorter than if the entry point of the pathogen is at a different point. The disease often begins on one side, but as it progresses, both eyes are often infected.