Neuro-ophthalmic complications of juvenile rheumatoid arthritis: a case report and review of literature
Afekhide Ernest Omoti, Joseph Momodu Waziri-Erameh, Vivian Bose Osaguona
Am J Case Rep 2008; 9:147-150
Background: The association between inflammatory ocular and articular disease is a strong one, although the pathogenesis of this relationship is obscure. Several ophthalmic disorders may occur in rheumatic diseases including keratoconjunctivitis sicca, ulcerative keratitis, scleritis, uveitis, retinal vascular disease, and neuro-ophthalmic lesions. Neuro-ophthalmic complications are not common in juvenile rheumatoid arthritis. The aim of this study is to report a series of neuro-ophthalmic complications in a Nigerian patient with juvenile rheumatoid arthritis.
Case Report: A nine year old female who was being managed for pauciarticular juvenile rheumatoid arthritis was referred to DDS Eye Clinic, Benin City, Nigeria, on the 8th of April 2007 to rule out uveitis. There was no uveitis. She later developed left retrobulbar neuritis with a vision of no perception of light. She was treated with corticosteroids. Her vision recovered completely but she subsequently developed left oculomotor nerve paresis with double vision. She also recovered completely.
Conclusions: Juvenile rheumatoid arthritis may be complicated by neuro-ophthalmic complications such as optic neuritis and cranial nerve paresis and require prompt diagnosis and treatment. A close collaboration between the treating paediatrician or rheumatologist and the ophthalmologist is essential to prevent potentially devastating outcomes if treatment is delayed.
Keywords: rheumatoid arthritis, optic neuritis, oculomotor paresis