Optic neuropathy in children with Lyme disease

Involvement of the optic nerve, either because of inflammation or increased intracranial pressure, is a rare manifestation of Lyme disease. Of the 4 c hildren reported here with optic nerve abnormalities, 2 had decreased visio n months after disease onset attributable to optic neuritis, and 1 had head ache and diplopia early in the infection because of increased intracranial pressure associated with Lyme meningitis. In these 3 children, optic nerve involvement responded well to intravenous ceftriaxone therapy. The fourth c hild had headache and visual loss attributable to increased intracranial pr essure and perhaps also to optic neuritis. Despite treatment with ceftriaxo ne and steroids, he had persistent increased intracranial pressure leading to permanent bilateral blindness. Clinicians should be aware that neuro-oph thalmologic involvement of Lyme disease may have significant consequences. If increased intracranial pressure persists despite antibiotic therapy, mea sures must be taken quickly to reduce the pressure.