Orbital Myositis From Lyme Disease: Rare Eye Manifestations
Orbital myositis can rarely occur with Lyme disease
Eye muscle inflammation may cause pain, swelling, or double vision
Recognition may improve diagnosis and treatment
Orbital myositis is typically caused by systemic disease, such as Graves’ disease, or hematologic disorders like lymphoma, the authors explain. In these cases, myositis is often bilateral. Orbital myositis has also been reported as a rare manifestation of Lyme disease and may present with eye pain, swelling, or double vision.
In these two cases, orbital myositis was confirmed by MRI findings.
The following two cases illustrate how Lyme disease can present with inflammation of the orbital muscles causing swelling, pain, and visual symptoms.
Patient #1: 68-year-old female
“The 68-year-old patient had acute and recurrent episodes lasting from 2 to 4 weeks, occurring 2 to 4 times each year, of right orbital swelling and pain,” the authors wrote.
Each episode resolved spontaneously or with steroids and nonsteroidal anti-inflammatory drugs.
Lyme disease was suspected because the patient lived in a rural area of France highly endemic for Lyme disease. She also recalled numerous tick bites and had a history of an erythema migrans rash and arthralgia.
Testing for Lyme disease was positive, and the woman began treatment with doxycycline. Within 3 weeks, her symptoms had resolved.
“We reported the cases of two patients who presented with orbital myositis caused by Borrelia infection.”
Patient #2: 13-year-old female
The 13-year-old adolescent complained of unilateral orbital swelling complicated by exophthalmia and horizontal diplopia.
“MRI showed a hyperintense signal of right inferior and medial rectus muscles,” the authors wrote.
MRI findings were important because orbital muscle inflammation can overlap with autoimmune, inflammatory, or infectious conditions.
The patient lived in an area endemic for Lyme disease and had a recent tick bite followed by an erythema migrans rash.
Lyme disease testing was positive, and she was treated successfully with 4 weeks of doxycycline.
The authors reported “a resolution of ocular symptoms and a decrease of the MRI signal intensity” within 1 month.
Why orbital myositis can be missed
Orbital myositis is uncommon, and Lyme-associated orbital myositis is even rarer. Eye swelling, orbital pain, diplopia, or muscle inflammation may initially be attributed to autoimmune, inflammatory, infectious, or hematologic disorders.
When orbital swelling occurs after a tick bite, erythema migrans rash, or exposure in an endemic region, clinicians may need to consider ocular Lyme disease and other forms of neurologic Lyme disease.
Patients experiencing vision symptoms may also review other reported manifestations of Lyme disease and double vision.
Authors conclude
- “Orbital myositis is an unusual manifestation of Lyme disease, although it is likely that the condition is underdiagnosed.”
- “Unexplained muscle swelling occurring in a patient who has had a rash or a recent history of a tick bite in an endemic area for Lyme disease should prompt consideration of this diagnosis.”
Frequently Asked Questions
What is orbital myositis?
Orbital myositis is inflammation involving the muscles surrounding the eye. Symptoms can include swelling, pain, eye movement abnormalities, and visual symptoms.
Can Lyme disease cause orbital myositis?
Rarely. Case reports have described orbital muscle inflammation associated with Lyme disease.
Can Lyme disease cause eye swelling or double vision?
Yes. Lyme disease can occasionally lead to eye swelling, orbital pain, diplopia, or other ocular manifestations.
How was orbital myositis diagnosed in these cases?
Diagnosis involved clinical history, Lyme disease testing, and MRI findings demonstrating orbital muscle inflammation.
Can orbital myositis improve with antibiotics?
In these reported cases, orbital symptoms improved following doxycycline treatment.
Clinical Takeaway
Orbital myositis is a rare but reported manifestation of Lyme disease.
In patients with unexplained orbital swelling, eye pain, diplopia, or orbital muscle inflammation, a history of tick exposure, erythema migrans rash, or residence in an endemic area may be clinically important.
Orbital myositis should remain in the differential diagnosis when eye muscle inflammation occurs without another clear explanation.
Related Articles
Ocular Lyme disease
Lyme disease and double vision
Lyme disease associated with eye problems
Vision problems in Lyme disease
References
- Sauer A, Speeg-Schatz C, Hansmann Y. Two cases of orbital myositis as a rare feature of Lyme borreliosis. Case Rep Infect Dis. 2011;2011:372470. doi:10.1155/2011/372470. Epub 2011 Jul 28. PMID:22567470; PMCID:PMC3336248.
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
