Ocular manifestations in children and adolescents with Lyme arthritis

Background-Lyme arthritis is the most frequent late manifestation of Lyme b orreliosis and has been associated with ocular inflammation. Methods-A group of 153 children and adolescents with arthritis, 84 of whom had Lyme arthritis and 69 other causes of arthritis, were followed prospect ively for 22-73 (median 44) months in the course of a national study. Results-Three of 84 patients with Lyme arthritis had ocular inflammation (4 %), including keratitis, anterior uveitis, and uveitis intermedia. All thre e had symptoms of decreased visual acuity. Whereas anterior uveitis disappe ared without sequelae, a corneal scar and a permanent loss of visual acuity in the patients with keratitis and intermediate uveitis remained. Systemat ic examination of all patients revealed no further ocular involvement. Of 6 9 patients with other causes of arthritis who were followed in parallel as a control group, four of 15 patients with early onset pauciarticular juveni le rheumatoid arthritis had chronic anterior uveitis and two of 12 patients with juvenile spondyloarthropathy had acute anterior uveitis. Conclusions-Ocular involvement with keratitis, anterior uveitis, and interm ediate uveitis may occur in children and adolescents with Lyme arthritis. V isual loss appears to be symptomatic, making regular ocular screening of su ch patients unnecessary.