Can Lyme Disease Cause Eye Twitching? A Child With Opsoclonus
Opsoclonus causes rapid, involuntary eye movements
A child developed this rare manifestation of neuroborreliosis
Her symptoms resolved following IV antibiotic treatment
Can Lyme disease cause eye twitching? Lyme disease has rarely been associated with opsoclonus, a neurologic disorder that causes rapid, involuntary, multidirectional eye movements. However, opsoclonus is different from the common fluttering or twitching of an eyelid.
Opsoclonus consists of sudden, chaotic eye movements that may appear as jerking, darting, or dancing eyes. It can occur by itself or as part of opsoclonus-myoclonus syndrome (OMS), which may also involve muscle jerks, poor coordination, and difficulty walking.
In children, opsoclonus-myoclonus syndrome may occur in association with an infection, an immune-mediated response, or a tumor—particularly neuroblastoma. Sometimes, no cause is identified.
Opsoclonus is an exceptionally rare reported manifestation of neurologic Lyme disease. Gibaud and colleagues described a child with opsoclonus in their case report, “Opsoclonus in a child with neuroborreliosis.”1
How was Lyme disease diagnosed?
The diagnosis of Lyme neuroborreliosis was supported by several findings:
- Facial nerve palsy
- Abnormal cerebrospinal fluid findings
- Supportive Lyme disease serology
The physicians also investigated other important causes of opsoclonus, including neoplasia, but did not identify a tumor. The child’s rapid improvement following intravenous antibiotic treatment was consistent with their diagnosis.
Symptoms resolved after IV ceftriaxone
The girl was treated with intravenous ceftriaxone for three weeks. According to the case report, she experienced a complete resolution of her symptoms.
This response supports the authors’ conclusion that the opsoclonus was associated with Lyme neuroborreliosis. Nevertheless, an individual case report cannot establish how frequently this manifestation occurs or predict how another patient will respond.
Opsoclonus-myoclonus syndrome and Lyme disease
Opsoclonus may occur alone or in association with myoclonus and ataxia. This combination is known as opsoclonus-myoclonus syndrome.
Peter and colleagues previously reported opsoclonus-myoclonus syndrome as a manifestation of acute Lyme disease.2 The investigators suggested that Lyme disease could be considered among the potential conditions evaluated in patients with OMS.
Only a small number of Lyme-associated cases had been described when these reports were published. Therefore, opsoclonus should not automatically be attributed to Lyme disease. A careful neurologic evaluation is important because the differential diagnosis includes other infections, autoimmune disorders, medication effects, and cancer.
Is opsoclonus the same as an eye twitch?
No. The phrase “eye twitching” commonly refers to eyelid myokymia—the repetitive fluttering of an eyelid that may occur with fatigue, stress, caffeine use, or eye strain.
Opsoclonus involves movement of the eyes themselves rather than the eyelid. The eyes make rapid, involuntary movements in multiple directions while the person is awake. This distinction matters because new jerking eye movements, especially when accompanied by facial weakness, muscle jerks, balance problems, headache, or other neurologic symptoms, warrant prompt medical evaluation.
Frequently Asked Questions
Can Lyme disease cause eye twitching?
Lyme disease has rarely been associated with opsoclonus, which causes rapid and involuntary movements of the eyes themselves. This is different from the more common twitching of an eyelid.
What do opsoclonus eye movements look like?
Opsoclonus produces sudden, chaotic, multidirectional eye movements that may appear as rapid jerking, darting, or dancing eyes while a person is awake.
Can opsoclonus occur with other neurologic symptoms?
Yes. Opsoclonus may occur with muscle jerks and poor coordination as part of opsoclonus-myoclonus syndrome. Behavioral changes and sleep disturbances may also occur.
How was the child with Lyme disease treated?
The child described by Gibaud and colleagues received intravenous ceftriaxone for three weeks and experienced a complete resolution of symptoms.
Clinical Takeaway
Lyme disease can rarely be associated with opsoclonus, a disorder characterized by rapid, involuntary movements of the eyes themselves. In this child, facial nerve palsy, abnormal spinal fluid findings, supportive Lyme testing, exclusion of an identified neoplasia, and improvement following IV ceftriaxone supported a diagnosis of neuroborreliosis.
Because opsoclonus is different from an ordinary eyelid twitch and may have several serious causes, new erratic eye movements should receive prompt neurologic evaluation.
Related Articles
Growing list of eye problems in Lyme disease
Lyme disease causes double vision: case report
Lyme disease causes vision loss in a 46-year-old woman
Pediatric Lyme disease: symptoms in children and toddlers
References
- Gibaud M, Pauvert O, Gueden S, Durigneux J, Van Bogaert P. Opsoclonus in a child with neuroborreliosis: Case report and review of the literature. Archives de Pédiatrie. 2019;26(2):118–119.
- Peter L, Jung J, Tilikete C, Ryvlin P, Mauguiere F. Opsoclonus–myoclonus as a manifestation of Lyme disease. Journal of Neurology, Neurosurgery & Psychiatry. 2006;77(9):1090–1091.
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
