Can Lyme Disease Affect Your Eyes? Contrast Sensitivity Loss in PTLD
Lyme disease may be associated with eye and vision problems
Contrast sensitivity loss can affect reading and night driving
In PTLD, impairment was linked to neurologic and cognitive findings
Can Lyme disease affect your eyes? An observational study found that contrast sensitivity impairment was associated with higher odds of belonging to the post-treatment Lyme disease group and was linked to neurologic and cognitive abnormalities.
In their article, Contrast Sensitivity Loss in Patients With Posttreatment Lyme Disease, Rebman and colleagues examined whether contrast sensitivity was altered in patients with post-treatment Lyme disease.1
The findings suggest that some visual complaints associated with Lyme disease may involve neurologic visual processing rather than an abnormality detected by a routine eye examination.
What is contrast sensitivity?
Contrast sensitivity is the ability to distinguish an object from its background when the difference between the two is subtle. It differs from standard visual acuity, which measures how clearly a person can see high-contrast letters on an eye chart.
Contrast sensitivity becomes particularly important when visibility is reduced by low light, fog, rain, shadows, or glare. A person may have relatively normal visual acuity yet still have difficulty seeing under these real-world conditions.
Driving at night, recognizing faces, reading low-contrast print, walking in dimly lit areas, and navigating stairs all depend on adequate contrast sensitivity.
Arditi explained that contrast sensitivity is strongly associated with reading performance, mobility, driving, face recognition, and activities of daily living.2
What did the PTLD study find?
In this observational study, Rebman and colleagues compared patients with well-defined post-treatment Lyme disease with healthy controls. They found that contrast sensitivity impairment was associated with increased odds of belonging to the PTLD group.
The authors reported:
“CS impairment was associated with an increased odds of being in the PTLD group that was 2.6 times as high as those without CS impairment.”
This does not mean that patients experienced a 2.6-fold loss of vision. It means that participants with contrast sensitivity impairment had higher odds of being in the PTLD group than participants without the impairment.
The authors concluded:
“CS impairment in patients with PTLD is linked to signs of cognitive and neurologic impairment and may be a marker of illness severity.”1
The study identified an association but did not establish that Lyme disease directly caused the contrast sensitivity loss. It also did not demonstrate that contrast sensitivity testing can diagnose persistent infection or determine whether an infection has resolved.
How can contrast sensitivity loss affect daily life?
A loss of contrast sensitivity may make everyday visual activities more difficult, particularly when lighting is poor or the surrounding environment is visually complex.
Patients may experience difficulty with:
- Driving at night or in fog, rain, or glare
- Reading faint or low-contrast print
- Recognizing faces in dim lighting
- Walking safely in shadows or poorly lit areas
- Seeing steps, curbs, and uneven surfaces
- Tolerating visually busy or crowded environments
These limitations can be especially confusing when a standard eye examination or visual acuity test is normal.
Other eye and vision problems reported in Lyme disease
Published reports have described several types of eye and visual changes in patients with Lyme disease. These include light sensitivity, blurred vision, double vision, difficulty reading, visual fatigue, optic neuritis, and abnormal eye movements.
A report from the Padula Institute of Visual Rehabilitation described a 20-year-old woman with headaches, eyestrain, occasional double vision, extreme light sensitivity, dizziness, and balance problems.3
Her symptoms fluctuated from day to day. Reading and other near work produced headaches and double vision. She also reported fatigue after reading, brain fog, difficulty tolerating busy environments, a reduced attention span, and problems functioning in school.
These complaints illustrate how visual-processing problems may overlap with dizziness, imbalance, fatigue, and other neurologic symptoms of Lyme disease.
Another study described a 46-year-old woman who developed sudden bilateral vision loss and paresthesias. She was ultimately diagnosed with optic neuritis secondary to Lyme disease.4
Gibaud and colleagues described a 9-year-old girl who presented to an emergency department with headaches, involuntary erratic rapid eye movements known as opsoclonus, and left peripheral facial palsy.5 Her abnormal eye movements resolved following antibiotic treatment.
These reports involve different potential mechanisms. Some symptoms may arise from inflammation within the eye or optic nerve, while others may reflect cranial nerve involvement or changes in how the brain processes visual information.
For a broader discussion, read Visual Changes in Lyme Disease: Blurred Vision and Light Sensitivity.
When should visual symptoms be evaluated?
Eye and vision symptoms have many possible causes unrelated to Lyme disease. Blurred vision, light sensitivity, double vision, visual fatigue, or difficulty seeing at night may also occur with migraine, diabetes, medication effects, autoimmune disorders, multiple sclerosis, cataracts, retinal disease, or other neurologic and ophthalmologic conditions.
Lyme disease may be considered as part of the differential diagnosis when unexplained visual symptoms occur with a history of tick exposure or with other compatible findings, such as facial palsy, headaches, neuropathy, joint pain, cognitive difficulties, or persistent fatigue.
Sudden vision loss, new double vision, severe eye pain, a new visual-field defect, facial weakness, or other acute neurologic symptoms warrant prompt medical evaluation.
Frequently Asked Questions
Can Lyme disease affect your eyes?
Yes. Lyme disease has been associated with blurred vision, light sensitivity, double vision, optic nerve inflammation, abnormal eye movements, and visual-processing difficulties. However, these symptoms have many other possible causes and require appropriate evaluation.
What is contrast sensitivity loss?
Contrast sensitivity loss is a reduced ability to distinguish an object from its background when the difference in brightness or color is subtle. It can interfere with night driving, reading faint print, recognizing faces, and walking in dim lighting.
Can someone have contrast sensitivity loss with normal visual acuity?
Yes. A person may read a standard high-contrast eye chart normally but still have difficulty seeing in low light, fog, glare, or other low-contrast situations.
Is contrast sensitivity testing diagnostic for PTLD?
No. The Rebman study found an association between contrast sensitivity impairment and PTLD, but contrast sensitivity testing has not been established as a diagnostic test for PTLD, persistent infection, or resolution of infection.
Can Lyme disease make night driving difficult?
Reduced contrast sensitivity may make it harder to see pedestrians, road markings, curbs, or other objects under low-light conditions or in rain, fog, and glare.
Do Lyme-related visual symptoms always come from the eyes?
No. Some symptoms may arise from inflammation within the eye, while others may involve the optic nerve, cranial nerves, or neurologic pathways responsible for processing visual information.
Clinical Takeaway
Contrast sensitivity measures an aspect of vision that is not captured by a standard visual acuity test. Reduced contrast sensitivity may help explain why some patients struggle with night driving, reading, mobility, or visually demanding environments despite having relatively normal visual acuity.
The Rebman study found that contrast sensitivity impairment in patients with PTLD was associated with neurologic findings and selected cognitive impairments. However, the study does not establish contrast sensitivity testing as a diagnostic marker of persistent infection.
Unexplained visual symptoms in a patient with Lyme disease deserve careful evaluation because they may reflect ocular disease, optic nerve involvement, neurologic visual-processing dysfunction, or a condition unrelated to Lyme disease.
Related Articles
Can Lyme Disease Cause Vision Loss or Optic Neuritis?
Erratic Rapid Eye Jerks in a Child With Lyme Disease
Eye Problems in Tick-Borne Diseases Other Than Lyme
References
- Rebman AW, Yang T, Aucott JN, Mihm EA, West SK. Contrast Sensitivity Loss in Patients With Posttreatment Lyme Disease. Transl Vis Sci Technol. 2021;10(3):27. doi:10.1167/tvst.10.3.27.
- Arditi A. Improving the design of the letter contrast sensitivity test. Invest Ophthalmol Vis Sci. 2005;46(6):2225-2229. doi:10.1167/iovs.04-1198.
- Padula Institute of Visual Rehabilitation. Lyme and Tick-borne Disease: Compromise of Visual Processing. Primary Care Optometry News. Accessed July 11, 2026.
- 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.
- Gibaud M, Pauvert O, Gueden S, Durigneux J, Van Bogaert P. Opsoclonus in a child with neuroborreliosis: Case report and review of the literature. Arch Pediatr. 2019;26(2):121-123.
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
Poor contrast sensitivity is also associated with biotoxin illness, most often from mold growth in water damaged buildings. There is a subgroup of patients, about 25%, who genetically lack the ability to clear these toxins, even after leaving the building. Severe inflammation and immune dysregulation develop. Such patients have difficulty clearing tick borne infections, despite aggressive treatment. It is also difficult to distinguish between symptoms of ongoing Lyme disease and biotoxin illness. It is possible that some patients with PTLD are living or working in moldy environments. It is also possible that Lyme alone could cause changes in contrast sensitivity, as it also is inflammatory and affects the nervous system. A definitive test to detect on going infection would help greatly.