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.
Susan Anderson
08/08/2017 (6:23 am)
My relative has Lyme and has had lots of problems . Her eye Dr just told she has more shots spots on her eyes Started with one now in both eyes. Compared them to cigarette burns. Said they would watch them, is there a treatment for this condition?
Dr. Daniel Cameron
08/08/2017 (11:21 pm)
I was impressed as to how many eye problems have already been described in Lyme disease. You would need to take the question to an ophthalmologist.
kalle kolpi
08/02/2017 (2:33 pm)
Please help me!
Can round retinal holes be caused by Lyme-disease?
The ophtalmologist i went to last week said i have round holes (he called them tufts) in the retina in both eyes. He said its a “genetic thing” and doesn’t require laser surgery because its very unlikely a retinal detachment will come from this. But is he able to see if these holes will stay like this or if they progress and get bigger or if i get more holes over time? Also a year before these holes were found i was examined by another ophtalmologist and before that i was examined by several other ophtalmologists and none of them had seen holes in my retina. The ophtalmologist who found the retinal holes said it’s because they weren’t visible back then, they became visible now because i got older. He said they didn’t develop in this one year where i hadn’t seen any ophtalmologists. I went to all these ophtalmologists because for more than 2 years i’ve been suffering from a condition called visual snow and it has been getting worse. I have read online that some people who have lyme-disease also experience visual snow that’s why i thought i might have lyme-disease as well. But my eyes were healthy all this time until recently when they found these holes. Im very afraid that these holes are caused by lyme disease and that they get bigger or that i get more holes. Can anyone help me with this? Does lyme-disease cause retinal holes and can they get bigger or can more holes develop? And would the ophtamologist have seen it, if these holes are caused by other things (such as lyme-disease)?
Thank you for your answeres, i very much appreciate it. (I’m from germany, excuse my english)
Dr. Daniel Cameron
08/02/2017 (11:43 pm)
It is unclear what is causing your condition. You should continue to be evaluated by several specialists
kalle kolpi
08/04/2017 (9:58 am)
Thank you for your anwer Dr. Cameron! Yes i stll visit doctors, but unfortunately nobody was able to help me so far. But my question is, is it possible that lyme-disease causes retinal holes? Thank you for your replies.
Dr. Daniel Cameron
08/04/2017 (11:06 pm)
I am not sure anyone has investigated that question.
kalle kolpi
08/05/2017 (4:53 pm)
Ok. Thank you for your answer. If you get any information on this in the future, please let me know.
Brian Brown
11/20/2018 (10:20 pm)
Same problem as Kalle. I have a retinal hole in one eye and torn retina in the other. I took a test for Lyme that came up negative but I have history with other insect bites and I have endured the night sweats and headaches and am convinced that this might be the problem with the eyes. Both eyes have been lasered but this is not treating the cause.
Inga Tice
06/28/2020 (11:17 am)
I was diagnosed with the retinal hole, floaters, sudden blur and double vision. A year later IGeneX (best test in US) confirmed a positive test for Lyme/bartonella.
Ruth F
07/26/2017 (10:47 pm)
I was diagnosed with Lyme in 2014 and was told I most likely was infected several years earlier. My biggest symptom has been brain fog until last year at which point I had what I will call an episode of heat exhaustion which precipitated exacerbation of my symptoms and the immediate onset of visual issues such as floaters, static type vision, light sensitivity, headaches and auras that stay with me every day. Note, prior to this episode I had almost perfect vision. I am now being treated by an LLMD and am 2 months into antibiotic treatment. I would say I have so far experienced a small reduction in my symptoms since starting the treatment. I am also taking several herbals as well. I have been wondering if my symptoms are originating from my eyes or if brain involvement is a contributing factor. I have had an MRI scan and an EEG without any significant findings.
Dr. Daniel Cameron
07/27/2017 (12:58 am)
I am happy to hear you have shown some improvement. I don not think anyone has an answer to your question.
Karen M
07/19/2017 (5:42 pm)
I had early cataracts in both eyes, developed after I got sick with very late stage Lyme and several other TBDs. I read that syphilis is on the differential diagnosis list for cataracts. Shouldn’t Lyme also be on that list? My cataracts started at 51, neither sister has them and my mother’s only began at 70 or so.
Dr. Daniel Cameron
07/20/2017 (5:43 am)
There are many unresolved questions in tick borne illnesses. I have been encouraged by the growing numbers of specialists looking a second time as the link between tick borne illnesses and common diseases.
Gail Wheeler
05/20/2017 (5:55 pm)
Dr. Cameron, you were the first doctor I saw for lyme after my regular GP. I had lyme twenty years ago and seem to have “recovered” though one never knows. Every member of my family has been infected with lyme or other tick borne illness. Among them, there are a number of eye issues. My husband has Fuchs’ Dystrophy and my grandmother, who at the time of infection was quite elderly, lost her peripheral vision in the space of several weeks and then went totally blind. She died, in my opinion, from lyme complications and was never truly treated. My brother in law, a pilot, has had positive lyme tests and suffers from ocular migraines and terrible eye pain. I believe it is all related to tick borne illness and not being adequately treated. GP’s are saying such things as, “lyme disease is over diagnosed” and “one week of antibiotics should take care of it”! Infection is rampant, yet much of the mainstream the medical community remains in denial. The height of arrogance irresponsibility.