Vision loss from Lyme disease in a teenager

Vision loss from Lyme disease in a teenager
Intracranial hypertension and papilledema can threaten vision
Prompt diagnosis and treatment may improve outcomes

Vision loss from Lyme disease is uncommon but can occur in patients with neurologic involvement. This case of vision loss from Lyme disease describes a teenager who developed intracranial hypertension, papilledema, and progressive neurologic symptoms despite initial treatment.

“We present a rare case of intracranial hypertension due to Lyme disease” in a pediatric patient treated with EVD placement for CSF diversion and intravenous ceftriaxone, resulting in significant improvement in symptoms including vision loss, the authors state.

A 13-year-old boy was admitted to the emergency department with headaches that had persisted for 4 weeks, neck stiffness, nausea, vomiting, abdominal pain, and progressive vision loss that worsened over 1 week.

Patients with neurologic manifestations may present with symptoms overlapping those described in Lyme disease symptoms guide and neurologic Lyme disease, especially when headaches, neck stiffness, visual symptoms, or cognitive complaints occur together.

How Lyme disease may cause papilledema and vision loss

Neurologic Lyme disease can occasionally contribute to elevated intracranial pressure. When pressure rises around the optic nerves, papilledema may develop, increasing the risk of blurred vision, transient visual obscurations, or progressive vision loss.

Visual symptoms associated with Lyme disease may include blurry vision, eye pain, double vision, visual field changes, optic nerve involvement, or papilledema. Additional ocular complications are discussed in ocular Lyme disease.

Raised intracranial pressure, papilledema, and visual symptoms are not specific to Lyme disease and clinicians often consider a broad differential diagnosis when these findings occur.

MRI findings suggested papilledema and increased intracranial pressure

Two weeks earlier, the teenager tested positive for Lyme disease and began doxycycline treatment. The following week, testing was positive for Babesia and clinicians prescribed atovaquone and azithromycin.

Although the patient received azithromycin for Babesia coinfection, the report attributed the visual symptoms and raised intracranial pressure to neuroborreliosis rather than medication toxicity.

However, symptoms worsened and MRI demonstrated “bilateral posterior scleral flattening, prominent optic papillae at the site of optic nerve insertion, tortuosity of the intraorbital optic nerves, and prominence of the optic nerve sheath complex.” These findings suggested papilledema and increased intracranial pressure.

Clinicians evaluating headache with papilledema, visual symptoms, or raised intracranial pressure may consider a broad differential diagnosis because these findings are not specific to Lyme disease.

Why treatment changed during hospitalization

Although Lyme testing remained positive, “a peripheral smear to identify Babesia species was negative on two separate studies,” the authors state. Therefore, treatment was changed to IV ceftriaxone.

“Given concern for idiopathic intracranial hypertension (IIH), he was also started on acetazolamide,” the authors explain. Because vision loss continued progressing, clinicians placed an external ventricular drain (EVD) for cerebrospinal fluid diversion.

The EVD remained in place for 12 days to allow CSF drainage and pressure reduction.

Complex multisystem presentations involving dizziness, autonomic symptoms, headache, and visual changes may overlap with manifestations discussed in autonomic dysfunction in Lyme disease.

Outcome after treatment

After completing a 3-week course of IV ceftriaxone, the teenager experienced complete resolution of vision loss, headaches, neck stiffness, nausea, and vomiting.

This report highlights that progressive visual symptoms accompanied by severe headache or papilledema should prompt consideration of increased intracranial pressure and neurologic complications.

Authors conclude

• “Intracranial hypertension with resulting neurological deterioration, while uncommon, can occur in patients with Lyme disease.”
• “While neurosurgical intervention in cases of Lyme disease is uncommon, it is important for neurosurgeons to be aware of disease complications that may require neurosurgical expertise.”

Frequently Asked Questions

Can Lyme disease cause vision loss?

Yes. Although uncommon, Lyme disease vision loss has been reported in association with papilledema, optic nerve involvement, cranial neuropathies, and intracranial hypertension.

What symptoms may suggest intracranial hypertension in Lyme disease?

Persistent headaches, nausea, vomiting, neck stiffness, blurred vision, transient visual symptoms, papilledema, and raised intracranial pressure may suggest elevated intracranial pressure.

Can pediatric Lyme disease affect the eyes?

Yes. Pediatric Lyme disease can occasionally affect visual pathways, cranial nerves, or intracranial pressure regulation, leading to eye symptoms or vision changes.

Can Lyme disease cause papilledema?

Papilledema has been reported in rare cases of neurologic Lyme disease, particularly when increased intracranial pressure develops.

Clinical Takeaway

Vision loss from Lyme disease is rare but may occur when neuroborreliosis is complicated by papilledema and intracranial hypertension.

Patients with worsening headaches, visual changes, papilledema, or neurologic decline warrant careful evaluation because delayed recognition may increase the risk of permanent complications. Progressive vision symptoms accompanied by headache or signs of increased intracranial pressure should prompt urgent evaluation for neurologic complications.

Related Articles

Lyme meningitis symptoms and complications
Ocular Lyme disease and eye complications
Brain fog and neurologic symptoms in Lyme disease
POTS and autonomic dysfunction in Lyme disease

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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