Eye Problems in Lyme Disease and Coinfections
Ocular symptoms can occur in Lyme disease, but they may also be seen—less commonly—in other tick-borne infections.
“Knowledge of systemic and ophthalmic manifestations combined with an understanding of the epidemiology of disease vectors is crucial for the diagnosis of tick-borne diseases,” explains Sathiamoorthi.
While eye involvement is described in Lyme disease and Rocky Mountain spotted fever, it appears to be less common in infections such as babesiosis, tick-borne relapsing fever, Powassan virus, ehrlichiosis, anaplasmosis, and Colorado tick fever.
Challenges in Recognizing Ocular Involvement
The true prevalence of ocular involvement in tick-borne diseases remains unclear. Diagnostic limitations may contribute to underrecognition.
Serologic testing can be negative early in illness. Patients who have been symptomatic for only a short time may not yet have detectable antibody responses.
At the same time, testing must be used thoughtfully to avoid false positive results.
When More Than One Infection Is Present
Diagnosis becomes more complex when multiple tick-borne infections are involved.
One case report described a patient with optic neuritis and orbital myositis who had serologic evidence of ehrlichiosis, Lyme disease, and Babesia.
In these situations, it may be difficult to determine which infection is responsible for specific ocular findings.
Tick Species and Ocular Disease
Several tick species have been associated with ocular manifestations, including:
- Ixodes scapularis
- Amblyomma americanum
- Dermacentor variabilis
- Dermacentor andersonii
- Ornithodoros species
This reflects the broader range of pathogens that may contribute to eye-related symptoms.
Clinical Clues That May Help
Careful history remains important when evaluating ocular complaints.
Patients more likely to have ophthalmic Lyme disease may have:
- Ocular findings associated with Lyme disease (such as cranial nerve palsies or keratitis)
- History of tick exposure in endemic areas
- Other systemic features (arthritis, carditis, neurologic symptoms)
- Negative evaluation for alternative causes such as syphilis
Clinical Perspective
Ocular symptoms in Lyme disease and coinfections are uncommon but clinically important.
Diagnosis often depends on recognizing patterns—combining eye findings with exposure history and systemic symptoms.
Patients may benefit from understanding Lyme disease symptoms, reviewing testing limitations, and considering coinfections when eye symptoms remain unexplained.
For more detail, see A growing list of eye problems in Lyme disease.
References
- Sathiamoorthi S, Smith WM. The eye and tick-borne disease in the United States. Curr Opin Ophthalmol. 2016.
- Pendse S, Bilyk JR, Lee MS. The ticking time bomb. Surv Ophthalmol. 2006.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I have made to have shots in my eye plus eye surgery. We are trying to save my eye. I had two Lyme test come back negative. And I have been sick off and on all year. With things never happened to my body before. They cannot find out the source of this infection. I know I have line that I cannot get them to listen to me. What can I do if my test keep coming back negative
There are so many causes for eye problems beyond Lyme disease. Your doctor will have to use clinical judgment to determine whether to treat for Lyme disease if the test are negative.
My eyes are sensitive to light is this a problem many people complain about.
I have ocular toxoplasmosis has anyone ever tested you for this?
Toxoplasmosis can cause problems in HIV disease. I have not seen any work on whether toxoplasmosis is a problem for Lyme disease patients.
My husband is desperate for answers regarding his permanent vision loss in one of his eyes (he is 39 years old, non-smoker, in great physical shape, doesn’t drink or so drugs). He has had chronic Lyme and Erhlicosis (he was hospitalized). He is mostly outdoors for work and gets bit regularly. He has seen multiple doctors with no answers—they are at a loss because all the testing comes back normal. He is in chronic eye pain, eye pressure, chronic headaches, blurry vision (separate from his eye loss), and heart palpitations. Lyme testing comes back low levels. I know erhlicosis can cause blindness in dogs but are there studies showing it can affect the optic nerves in the eye causing blindness in humans?
I have not seen permanent vision loss in my patients. I wrote the following blog from a published case. https://danielcameronmd.com/lyme-disease-vision-problems/
The fact that tick-borne diseases can affect the eyes in various ways is both concerning and enlightening. Your detailed exploration of these ocular manifestations not only raises awareness but also emphasizes the importance of recognizing symptoms beyond the typical manifestations of tick-related illnesses.