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Mikel Shea Ehntholt, Gerald W Zaidman; Unilateral Diffuse Nummular Infiltrates and Microcystic Edema Secondary to Lyme Disease in the Pediatric Population. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2828.
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To report three cases of Lyme disease that presented as unilateral interstitial keratitis and associated microcystic corneal edema in teenagers.
Case report and review of the available literature.
Three teenagers ranging in age from 14-17 years old (mean age, 15.3 yrs.) presented with decreased visual acuity, photophobia, and tearing in one eye. Unilateral diffuse nummular infiltrates were seen under slit lamp examination. Two patients also had associated microcystic corneal edema. Corneal pachymetry was recorded at 981 μm and 860 μm in the affected eyes and 608 μm and 620 μm in the normal. A work-up and serologic testing revealed positive Lyme IgG titers by western blot. Patients were treated with systemic antibiotics and topical fluorometholone 0.1% eye drops. There was complete resolution of the interstitial keratitis and the corneal edema in all patients as visual acuity returned to normal.
Lyme disease is a multisystem spirochetal disorder that occurs in three stages. Generally, patients may present with ocular manifestations during the systemic late stage II or stage III of the infection. Interstitial keratitis has been reported during stage III in adults with Lyme disease but only rarely in a pediatric population. Although keratitis is usually bilateral in presentation, here we present unilateral cases. Additionally, there are no reports of microcystic corneal edema associated with Lyme interstitial keratitis. Therefore, teenagers presenting with unilateral corneal edema and interstitial keratitis should be evaluated for Lyme disease. Treatment requires systemic antibiotics and topical corticosteroid therapy. Topical therapy using 0.1% fluorometholone has proven to be effective treatment for interstitial keratitis while minimizing the adverse effects.
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