Growing list of eye problems in Lyme disease
Ophthalmic manifestations of tick-borne diseases are increasing in the United States, according to a review published recently in Current Opinion in Ophthalmology. And, "although ocular involvement can be self-limited, delays in diagnosis may result in vision impairment and even blindness," stated Sathiamoorthi from the Mayo Clinic. [1]
The authors described eye problems in lyme disease presenting with the following ophthalmologic findings:
- Follicular conjunctivitis
- Periorbital edema and mild photophobia
- Bell’s palsy, cranial nerve palsies and Horner syndrome
- Argyll Robertson pupil
- Keratitis
- Optic neuritis, papilledema, papillitis and neuroretinitis
- Myositis of extraocular muscles and dacryoadenitis
- Episcleritis, anterior and posterior scleritis
- Anterior, intermediate, posterior and panuveitis
- Retinal vasculitis, cotton wool spots and choroiditis
- Retinitis, macular edema and endophthalmitis
The authors point out that optic neuritis, which is often seen in multiple sclerosis, occurs in Lyme disease, as well. Furthermore, they remind readers that although it is rare, uveitis can also be found in Lyme disease (LD). “Findings include vitreitis, retinal vasculitis, cotton wool spots, choroiditis, macular edema and endophthalmitis,” stated Sathiamoorthi. “In several cases, spirochetes were detected in vitreous material.”
Uveitis is inflammation of the uvea, which is made up of the iris, ciliary body and choroid. Anterior, intermediate and posterior uveitis as well as panuveitis has also been described. [2]
The “degree and frequency of ocular signs and symptoms varies widely between the different [tick-borne] diseases,” the authors point out.
These eye problems have been associated with a wide range of acute and chronic presentations. “Patients with anterior uveitis usually complain of pain, redness, blurred vision, and photophobia, watering,” according to Agrawal from the Medical Research Foundation, India. [3] “Most of the patients would have had repeated attacks and would have sought consultation with multiple ophthalmologists and would have used topical and/or systemic medications on and off.”
Ocular complications are infrequent but can be serious. “Complications such as macular edema, chorioretinitis and optic neuropathy may be vision-threatening and require treatment with corticosteroids as long as the recommended antimicrobial regimen has been instituted,” stated Sathiamoorthi.
The true incidence of eye problems in lyme disease, however, remains unknown. According to Sathiamoorthi, one case of seronegative uveitis was discredited. “At least one of the earlier case reports of Lyme uveitis found spirochetes in vitreous material, yet serological testing was negative for Lyme antibodies.”
The authors conclude the “degree and frequency of ocular signs and symptoms varies widely between the different [tick-borne] diseases.” Furthermore, opthamologists should be “alert to the possibility of an infectious cause depending on the patient’s risk factors.”
Related Articles:
Erratic rapid eye jerks in a child with Lyme disease
References:
- Sathiamoorthi, S. and W.M. Smith, The eye and tick-borne disease in the United States. Curr Opin Ophthalmol, 2016. 27(6): p. 530-537.
- Sudharshan, S., S.K. Ganesh, and J. Biswas, Current approach in the diagnosis and management of posterior uveitis. Indian J Ophthalmol, 2010. 58(1): p. 29-43.
- Agrawal, R.V., et al., Current approach in diagnosis and management of anterior uveitis. Indian J Ophthalmol, 2010. 58(1): p. 11-9.
Adriana Galindo
04/25/2017 (2:00 am)
I have been diagnosed with acute lyme disease over a year ago. It was discovered when my left eye was hurting like sinus pressure so I went to see an eye doctor, there they diagnosed it as optic neuritis. That doctor admitted me into the hospital for IV steriods. But then referred me to a neuro ophthalmologist that did a Western Blot and found the lyme. Thing is, I feel like a lab rat. I haven’t been able to get off the predisone since being diagnosed over a year ago. I’ve went from 20 mg up to 80 mg when my eye has gotten bad. I haven’t had to be increased on the predisone that high for about 7 months now, which is the longest time in which it hasn’t swollen on me or hemorrhaged. But I feel I’m getting no where on getting off predisone, if we lower it my eye reacts in a negative way and within 2 days I have to increase my predisone back to mg a day. I feel I’m on a merry go round that I can’t get off. Any assistance would be helpful on someone with the similar issue that actually was able to get their eye under control to get off predisone. Or a place within the Dallas, TX area or wherever I need to travel. Houston, any city in the US just to get this controlled and hopefully behind me.
Adriana Galindo
Dr. Daniel Cameron
04/25/2017 (1:00 pm)
Doctors are divided as to whether a persistent infection might underlie common chronic condition. You may find it helpful to be reevaluated for Lyme disease again. I am not familiar with who to see in your area.
Kim
06/26/2018 (1:26 pm)
I’m wondering if you have had any luck getting off predisone. We are in the exact same situation. Would love to hear how you are doing now and what you have done in the past year since you posted this. Thanks
Donna Falcone
12/22/2016 (11:20 am)
Hi Dr. Cameron,
Is severe eye dryness a condition you have seen or read about in Lyme patients? Might it be caused by medications taken to treat TBDs? What is your experience? Thank you for talking about ocular manifestations of TBDs.
Dr. Daniel Cameron
12/25/2016 (6:14 pm)
Dry eyes occur in Lyme disease but they also are common in other conditions. You should include an ophthalmologist in your evaluation.
Shannon Sparrow
06/07/2018 (3:58 pm)
I have late stage lyme. Not chronic anymore but still dealing with fatigue and muscle joint issues as well as eye problems. I get floaters now and my vision is so much weaker now. I am 41 so I guess my vision is naturally getting worse but it has gotten worse rapidly. Some of my first symptoms of lyme were chronic dry eye and oh..i t feel like I have sand under my eyelid in certain spots.
Dr. Daniel Cameron
06/07/2018 (6:51 pm)
It can be difficult to be sure a tick borne infection is clear. I found it interesting to review an article summarizing the range of eye issues related to Lyme disease.
Thom
10/16/2018 (6:39 pm)
Hi,
Could it be a Sjogren disease instead?
Symptoms are perfectly matching.
Dr. Daniel Cameron
10/17/2018 (9:16 am)
This comment highlights the challenges doctors face when the clinical presentations is similar for more than one condition. The symptoms overlap in part if they are driven by an overactive immune response. I might consider a rheumatologic consultation.
Thom
10/23/2018 (11:33 am)
Trouble is when all Sjogren symptoms are present but the objective criteria (blood analysis & biopsy negative for Sjogren).
Doc explains no conclusions can be done and it’s needed to wait for stronger evidences (ie more damages 🙁 ).
More evidence can take more than 10years.
So, it’s accepted to be diagnocated ‘probably Sjogren’, even with quite no evidences (except dryness), while the option for Lyme is closed after the Elisa+WB.
Dr. Daniel Cameron
10/23/2018 (12:50 pm)
Well stated.
Ketti Parente
12/19/2016 (7:29 pm)
My 7 year old daughter has experienced what we call “visual snow” for 2.5 years. Around her 5th birthday we discovered that she sees static all the time. We are not sure if it suddenly appeared the night she thought millions of bugs were flying around her room, or if she has always had this. Have you ever encountered any Lyme patients that dealt with something similar?
Dr. Daniel Cameron
12/25/2016 (6:16 pm)
There are a number of eye disturbances in Lyme disease that do not fall under a specific diagnosis. For example, there are often floaters that can increase in numbers. You should include an ophthalmologist as part of your evaluation.
Windy J Cumberbatch
12/19/2016 (12:21 am)
I found this to be quite helpful. I have Chronic Lyme Disease and was recently diagnosed as having Macula Degeneration. It seems also each year my eyesight changes, now I know why. Thank you so much.
Windy J Cumberbatch
Lyme Disease Advocate
Deanna
12/18/2016 (6:11 pm)
I have chronic Lyme disease and I have lost all of my peripheral vision in my right eye. After 2 years of eye care professionals all of who told me there wasn’t anything wrong with my eyes I finally found a Lyme literate eye doctor who at least acknowledges that there had been damage to my eyes.
Dr. Daniel Cameron
12/18/2016 (10:35 pm)
We are are grateful to the Mayo author for submitting a review of eye findings in Lyme and other tick borne illnesses.
Lizabella
10/18/2018 (6:37 am)
How did you find a Lyme eye doctor please help?
Brenda Kahn
01/05/2019 (2:04 pm)
Please read Kristin Reihman’s book Life After Lyme. She was my doctor in Pennsylvania and helped me recover from a very severe condition due to long term undiagnosed Lyme. I still have issues to resolve but her protocols were extremely helpful in my recovery. Her book can be a bit overwhelming in all the options, but the truth about curing Lyme is it’s a three level ongoing protocol 1- killing bugs 2- detoxing 3- empowering your mitochondria to work at an optimal level.
This can mean for example eating a paleo or a ketogenic diet , while you take antibiotics or herbs that kill bugs while at the same time you take coconut charcoal or digestable clay to detox
And it’s a balancing act because every person is different. Every person will react differently to lyme and the protocols that restore your health. So you have to be open to trial and error and be diligent about making your body as strong as it can be.
Lisa Marshall
01/26/2019 (6:21 pm)
Brenda, did you have ocular issues as well that were resolved? How long did it take before you saw real results from the protocol? Thank you for sharing about her as well as her book. Looking into this.