Unilateral Posterior Stromal Keratitis Possibly Secondary to Lyme Disease

PURPOSE:To report a case of Lyme disease presenting as unilateral posterior stromal keratitis in a pediatric patient. METHODS:Case report and review of available literature. RESULTS:A 13-year-old adolescent with unilateral painless blurry vision presented with prominent posterior corneal stromal haze. A positive Borrelia burgdorferi antibody enzyme immunoassay and Western blot analysis (9 of 10 reactive immunoglobulin G bands and 1 of 3 immunoglobulin M bands) confirmed the diagnosis. Treatment with oral antibiotics and topical corticosteroids were necessary for resolution. CONCLUSIONS:Lyme disease may present as a unilateral posterior stromal keratitis, even in a pediatric population. Treatment requires both systemic and topical therapy.