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.
Vicki
07/24/2018 (12:02 am)
I used to have perfect eye sight.
All of a sudden I was seeing black floaters and my short vision was declinimg. I was squinting in th4 glare. I developed astigmatism, droopy eye lids, conjunctivitis, dry eye, watery eyes.
Now my eyesight has gone to-3.75 and -3.50. I can’t wear contacts.
I got told this was all normal for a 47 yr old woman. ALSO told I couldn’t get laser to correct the issues.
Business is my biggest issue and judging distance especially in the evening.
Do you have any comments or suggestions.
Kind regards
Dr. Daniel Cameron
07/24/2018 (12:14 am)
I am pleased to see a few ophthalmologist are looking into eye problems. It can be difficult to determine whether additional treatment might help. You may also want to check with Dr. Padula in Connecticut who works with eye changes with neurologic events e.g. Lyme disease and strokes, to include rehabilitation.
JEFF
07/24/2018 (2:24 am)
Dr. Padula is one of the increasing number of specially trained Doctors of Optometry that are expert in neurologic manifestations of disease or trauma that affect vision. These highly qualified optometrists are Fellows of the College of Optometrists in Vision Development (FCOVD). Visit the COVD website (www.covd.org) for more information. One of these highly regarded specialists is Dr. Robert Fox, OD, FCOVD (www.FoxVisionDevelopment.com).
Dianne
06/21/2018 (10:11 pm)
I have been told to stay away from any shape or form of steroids if you have or possibly have Lyme!
Jane Howard
10/21/2019 (1:30 am)
Can you please tell me why you have to stay away from steroids if you have lyme. I have been using prednisolone drops for my eyes for posteria uveitis for over 2 years. I found out I have had lyme for at least a year. Thanks
Dr. Daniel Cameron
10/21/2019 (8:19 pm)
Sometimes my patients can not avoid steroids. I have patients whose uveitis resolved after treatment for their Lyme diseases allowing them to stop steroids. Of course, uveitis resolves by itself sometimes.
GG
05/03/2018 (1:12 am)
My 7yo son and I both have Bartonella henselae. He also has Lyme. I’m waiting on further Lyme testing for me. We are both on antibiotics for Lyme/Bart (and he is on monthly ivig temporarily to boost his immune system after Lyme destroyed it). He has had floaters, light sensitivity and worsening blurry vision since August 2017. He was diagnosed and on Lyme specific antibiotics in Jan 2018. I started feeling symptoms in March and had light sensitivity and blurry vision but got on antibiotics quickly so my vision is very manageable. We’ve been to prism glass eye drs, developmental optometrists and regular opthamologists including a uvietis specialist. Everyone says his eyes are fine physically and no Uveitis. His vision is very variable day to day and minute to minute. He has particular trouble seeing the letters in words and sentences especially when the lines are close together. For distance he’s been measured at 20-20 and 20-400 depending on the day. (1) is there any serious illness like those described above related to Lyme that all of his opthamologist exams would not have discovered in an exam? (2) any thoughts on what is going on and how to address? The opthamologists think it’s some brain issue like dyslexia. Since I have it too I can tell you the light sensitivity and blurry vision completely coincided with my other Bart symptoms and it’s a vision issue not something like dyslexia (and this was never an issue before Lyme for him). Please help. I’ve been to so many drs. It is interfering with his school work especially reading. I don’t know what other dr to go to at this point.
Dr. Daniel Cameron
05/03/2018 (2:12 pm)
It am happy to hear the ophthalmologists have not found another issues. I often see a sensation of blurred vision, as if the eyes don’t work so well together. I use Dr. Padula, from Connecticut to help at https://padulainstitute.com . You may find another tick borne infection e.g. Babesia might play a role.
Mom with Child w/Lyme Vision Problems
02/09/2019 (2:45 pm)
Hi GG!
I have been bringing my high school aged son to Dr.Padula for a few years now .
I am from CT. He sees a lot of children with vision problems and lyme. He has advanced equipment to measure effects on eye system differential to brain and also a walking tract with sensors to see if the vision is effecting the patients gait (walk).He prescribed the best pair of glasses for my son with prisms and they actually were not as strong as the previous ones. He was the first medical person to send my sons blood for Lyme testing to a lab in CA called IGenX. He said my son had the bio markers for lyme. He has been experiencing classroom vision problems from 2nd grade-11th grade now. The school’s implementation of the IDEIA program has been terrible. My sons pediatrician said he didn’t have Lyme. He used the CDC testing and maybe could not read the test. I brought my son to another MD who did CDC Eliza and Western Blot and confirmed the expensive IGEnX testing Dx of Lyme/Bartonella/Babesiosis. I never ever dreamed that this years long quest to find out why my tested and proven gifted son was sporadically missing things in class would turn out to be Lyme Desease which I had naively thought started with the bullseye skin rash and joint pain would be the cause of his classroom vision problems. I had taken him to 7 eye doctors in CT, MA, RI before hearing about Dr.Padula. Now the trouble for me is finding a lyme literate doctor who will accept my very good Insuance plan here in central CT. Does anyone have any recommendations? Why is it that so many of these Lyme Doctors say they won’t take any insurance? Have other patients been experiencing this? My daughter now in college had terrible problems with the double vision and what she described as “words falling apart on the page” starting in her 9th grade. I feet that she too had Lyme but I have not been able to convince her to be tested. I have Lyme.. They say it often runs in families and they do not know why. Maybe we have infected ticks somewhere around our homes or where we go? Maybe we are more sensitive to the infections from their bites? My friend in PA and her 2 children also tested positive. Interestingly her son and my son are both Boy Scouts and have spent a lot of time camping. I rarely spend time outside. The blurred vision for me comes and goes. I see it more when I am overtaxed. To me it looks like I am looking through a gel rather than clear air. People only 4-5 ft away look blurry. i hope your son finds some answers with Dr. Padula. I hope that his school district is more supportive than mine has been. My district has done nothing but faught the parents all the way. It seems they want to submit him on the headcount to the state to get the federal dollars but not spent a cent on proper evaluation, writing an appropriate IEP because they really do not know how to or desire to support a child with vision issues. I so hope you find better medical help and school support for your boy.
wendy
02/06/2018 (12:54 pm)
I was told over the past 8 years…I may have had Lyme. all sorts of tests …can it cause you to see a tick….i wake up at night and in my vision I see a bug…and it looks like a tick everytime. Doesn’t happen that much….but this week, it happened twice. one doctor said he felt the Lyme went to my brain….a Lyme specialist in Flemington, nj tolsd me since I had been on many antibiotics over the yrs for sinus stuff, the lyme would be gone. how do you rid eyes and brain of Lyme? Too many symptoms to list… unclear vision. eye pain, constant sinus pain, lots of sharo spots off and on ,vwerge of migraine auras, vision moves, ton of floaters, pain all over, feel sick constasntly,
…. but oprhamologist told me eyes are healthy. I did have water behind the eyes after i had my daughter, a preemie in 2007 due to high blood pressure, eclampsia. I digress….can Lyme be cause to all this? thank u
Dr. Daniel Cameron
02/07/2018 (12:35 am)
It is important to also make sure that there are no other issues unrelated to tick borne illnesses
Maria Tinajero
01/31/2018 (1:01 pm)
My Boyfriend got antibiotic treatment to kill the Lyme and now his eyes bulge out when he puts pressure on his head. Can Lyme cause the eyes to bulge out and if so what is the cause? Is it because of the inflammation after the treatment or is it because there’s damage done to the eyes?
Dr. Daniel Cameron
02/01/2018 (12:48 am)
I am not sure what is causing his symptoms. You should have your boyfriend evaluated by a neurologist and ophthalmologist to rule out another illness.