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.
Victoria Richardello
01/04/2018 (11:01 pm)
My mom has suffered with eye problems for almost a year. Her doctors here said all tests came back negative; there was nothing wrong, only dry eye. She also constantly complained about being tired and having no energy and really acted depresssed. Well, I finally took her to Boston. There she was diagnosed with uveitis and cornea problems, in both eyes. The retina doctor did numerous blood tests and still could not find out what was causing the inflammation in the back of her eyes. They would not do anything for the corneas until the inflammation had gone down. She was put on prednizone which brought it down substantially. Finally, a lyme test was done and it was found she has lyme disease and has had it for a long time. Can lyme disease cause such severe eye problems and will she get better? She is now on doxyclcline and feels a little better. I’m hoping we can improve her eyesight, too!
Dr. Daniel Cameron
01/10/2018 (1:36 pm)
Uveitis is one of the findings in Lyme disease. I was encouraged to read the review article connecting some eye problems with Lyme disease. It may take more than a simple 3 to 4 week course of antibiotics to resolve the uveitis.
Anna
12/08/2017 (6:53 am)
Nice post.
Wende
09/20/2017 (4:56 pm)
Thank you for you response and your research on this. I want to thank everyone else thats written about the effects on their eyes. I thought I was alone.
Wende
09/20/2017 (3:05 pm)
Hi Doctor Daniel, I lost some vision in my left eye, about 30%. I went to the eye doctor and he sent me to a retina specialist. He saw some swelling in my veins going to my retina. He sent me to have a MIR to see if i had a brain tumor or MS. He also sent me for a blood test. My MRI came back negative. My blood work show a false/positive for lyme, but the retina specialist had more testing done on my blood work and it came back positive. My doctors office called and asked if i remember being bit. I said that I had a bite on my stomach, which had the bullseye. She set up a appointment with the ID doctor. I went to him and he asked me why I thought I had Lyme disease. I said, the results are in my blood work. Well his office never received it, after 2 times my doctors office sent it. He went to say that lyme disease can not effect your eyes. Then he proceeded to his cell phone and started to read what lyme disease can cause. He said that there isn’t anything about eyes. I left very angry none tbe less. I called my doctors office about the blood work. They sent it for the 3rd time, and made sure the ID doctors office received it. It’s been over a week and I haven’t heard back from them yet.
Dr. Daniel Cameron
09/20/2017 (4:31 pm)
Doctors are divided on the topic. The first descriptions of Lyme disease as a rheumatologic problem are hard to change.
Fred
03/31/2018 (3:38 pm)
I recently saw an ID doc at albany med and he literally told me that there has only ever been 1 true case of lyme disease in NY state and that I don’t have lyme, though i tested positive after having the antibodies for over 4 years. I feel how angry you must have been. I believe I’ve had untreated lyme for around 4 yrs. Neuromuscular issues, eye issues and color change, mood swings from hell, sever muscle weakness, chronic infections, complete loss of taste and much more. I was only treated with 3 weeks of doxy, and actually ended up feeling worse. I’ve decided that too many doctors let their arrogance get in the way of actually doing their job.
DIMAS
09/15/2017 (4:01 am)
Hi Dr, Daniel. I went through several specialist who did not know exactly what happened to turn my visa right dark. I did commented to the optometrist and he then suspected it was tick disease. this took in california and was positive result. I’ve heard from him to say that,. the vision will not come back. But I do not give up believing that there will be a solution later. every day I wake up in the hope that I will have my vision back later. i need help, if I can talk about what I can expect. Thank you very much. God bless you all.
Dr. Daniel Cameron
09/15/2017 (4:55 am)
I am sorry to hear you have not been able to reverse your vision. I would make sure that Lyme or a coinfection have been treated. You also need to sure any other eye conditions are treated.