Opsoclonus in Lyme Disease: Erratic Eye Movements in a Child
Lyme disease can rarely affect eye movements.
Opsoclonus causes rapid, uncontrolled eye jerking.
This pediatric case improved after antibiotic treatment.
Opsoclonus—rapid, uncontrolled eye movements—is a rare neurologic manifestation of Lyme disease.
Opsoclonus is typically associated with infection or malignancy, particularly neuroblastoma. However, it has rarely been reported in Lyme disease, explain Gibaud and colleagues in a case report “Opsoclonus in a child with neuroborreliosis.”1
To date, only a few cases have been described in the medical literature.
Can Lyme Disease Cause Eye Twitching?
Some patients with neurologic Lyme disease describe eye twitching, eye jerking, or erratic eye movements. In rare cases, these symptoms may reflect opsoclonus or other neurologic eye movement disorders.
Opsoclonus involves rapid, involuntary, multidirectional eye movements that may interfere with balance, vision, and coordination.
Some patients describe opsoclonus as eye twitching or sudden eye jerking that feels uncontrollable.
Case Presentation
A child presented with erratic, rapid eye movements consistent with opsoclonus.
Lyme disease was diagnosed based on:
- Facial nerve palsy
- Abnormal spinal tap
- Supportive Lyme serologic testing
- Absence of malignancy
- Rapid response to antibiotic therapy
Treatment and Outcome
The patient was treated with a 3-week course of intravenous ceftriaxone.
Symptoms completely resolved following antibiotic treatment.
Opsoclonus-Myoclonus Syndrome (OMS)
Opsoclonus may occur alone or as part of opsoclonus-myoclonus syndrome (OMS), which includes myoclonus and ataxia.
OMS has also been reported in Lyme disease. Peter and colleagues suggest that Lyme disease should be included among conditions evaluated in OMS.
For more neurologic manifestations, see neurologic Lyme disease and eye problems in Lyme disease.
Why Lyme Disease Eye Symptoms Are Missed
Eye twitching, eye jerking, blurred vision, and abnormal eye movements are often attributed to stress, fatigue, or primary neurologic disease.
When these symptoms occur alongside facial palsy, headache, balance problems, or other neurologic symptoms, Lyme disease may need to be considered in the differential diagnosis.
Frequently Asked Questions
Can Lyme disease cause eye twitching?
Yes. Lyme disease may cause neurologic eye symptoms including twitching, jerking, blurred vision, double vision, or abnormal eye movements.
What is opsoclonus?
Opsoclonus is a rare neurologic condition involving rapid, involuntary eye movements in multiple directions.
Can Lyme disease cause opsoclonus-myoclonus syndrome?
Rare case reports have linked Lyme disease to opsoclonus-myoclonus syndrome (OMS), which may include abnormal eye movements, myoclonus, and ataxia.
Can Lyme disease affect the eyes?
Yes. Lyme disease may affect vision, eye movement, cranial nerves, and neurologic pathways involving the eyes.
Clinical Perspective
This case highlights the importance of considering Lyme disease in children with unexplained neurologic symptoms, including abnormal eye movements.
Early recognition is critical, as appropriate antibiotic treatment may lead to full recovery.
Clinical Takeaway
Opsoclonus is a rare but treatable neurologic sign of Lyme disease in children.
Related Articles:
References:
- Gibaud M, Pauvert O, Gueden S, Durigneux J, Van Bogaert P. Opsoclonus in neuroborreliosis. Arch Pediatr. 2019.
- Peter L, Jung J, Tilikete C, et al. Opsoclonus–myoclonus in Lyme disease. J Neurol Neurosurg Psychiatry. 2006.
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
