Lyme disease causes vision loss in 46-year-old woman
There have been several case reports linking Lyme disease with eye problems, including a loss of vision. In a study by the Mayo Clinic, researchers concluded that "although ocular involvement can be self-limited, delays in diagnosis may result in vision impairment and even blindness." 
by Daniel J. Cameron, MD, MPH
A recent article published in the Wisconsin Medical Journal describes the case of a 46-year-old woman who experienced a sudden onset of bilateral vision loss and paresthesias.
According to Jha and colleagues from the Medical College of Wisconsin, the woman developed blurred vision, which progressively worsened over a 3-week period.  This reportedly began after she had upper respiratory tract symptoms. In addition, the woman had nausea, weakness, dizziness, and tingling/numbness in her lower extremities.
“After extensive workup, she was diagnosed with Lyme optic neuritis based on the clinical presentation and positive serology,” writes Jha.
Optic neuritis is inflammation of the optic nerve. The condition typically causes temporary vision loss in one eye and is often associated with multiple sclerosis (MS).
In this case, the vision loss was significant. Using the Snellen Eye Test Charts her visual acuity was 20/400 in both eyes. Color vision was impaired in both eyes, as well. “A dilated fundus exam demonstrated bilateral optic head edema, hyperemia, and optic nerve elevation concerning for intracranial hypertension,” according to Jha.
Other conditions were ruled out. “The inpatient workup ruled out posterior reversible encephalopathy syndrome, idiopathic intracranial hypertension, multiple sclerosis, meningitis (viral, fungal, tuberculosis, syphilis, and other bacterial), autoimmune process and cerebrovascular disease,” Jha states.
The woman fulfilled the criteria for acute Lyme infection with a positive 2-tiered serology test (positive immunoassay). “Our case also fulfilled the criteria for acute Lyme disease with strong evidence of a causal link with optic neuritis, as described by Sibony,” writes Jha.Lyme and other tick-borne diseases can cause eye problems, including vision loss and blurred vision. Click To Tweet
The woman was prescribed 2 weeks of doxycycline but after one week was admitted to the hospital for alcohol intoxication. “Upon questioning, she endorsed some improvement in vision after initiation of antibiotic,” writes Jha.
But the final outcome is uncertain, since the woman left the hospital against medical advice and did not adhere to her follow-up appointments. “Whether her symptoms resolved completely thereafter is unknown,” Jha states.
The authors stress the need to include Lyme disease in differential diagnosis of optic neuritis. “More reporting of the cases is essential to draw enough attention from the clinicians and researchers to help devise evidence-based guidelines on the approach to diagnose and manage this condition.”
- Sathiamoorthi, S. and W.M. Smith, The eye and tick-borne disease in the United States. Curr Opin Ophthalmol, 2016. 27(6): p. 530-537.
- Jha P, Rodrigues Pereira SG, Thakur A, Jhaj G, Bhandari S. A Case of Optic Neuritis Secondary to Lyme Disease. Wmj. 2018;117(2):83-87.