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.
Kelly stanford
09/08/2018 (1:31 pm)
I have been diagnosed with lyme. I got bit on June in arkansas. Long story short this is my third round of antibiotics. But just 2 days into my 3rd round of cefuroxime my eyes are so painful and so painful to blink. They r somewhat bloodshot. But it is the pain that I’m concerned about. They were sort of matted this morning. I’m going to a llmd so just ur Opinion thanks
Dr. Daniel Cameron
09/09/2018 (12:05 pm)
It is important to include an ophthalmologist as part of your evaluation again if there is a new finding.
Marine
08/15/2018 (1:11 am)
Hello. I’ve had lyme disease undetected at the age of 11, but was diagnosed at age 15. I have many health related issues due to Lyme. The right side of my face feels slightly stiff and there is slight drooping of the right eye. Recently, I noticed that my right eye seems to be smaller than the left. Is this a side effect of the Lyme as well? Is there a name for this symptom? Is it reversible? It’s very distressing and affecting me greatly.
Dr. Daniel Cameron
08/15/2018 (1:06 pm)
There is a growing awareness of eye problems in Lyme disease including Argyll Robertson pupil and Horner’s syndrome. You can copy and paste one of my Lyme Disease Science blogs at https://danielcameronmd.com/growing-list-eye-problems-lyme-disease/ You should also rule out other illnesses.
Cynthia
07/24/2018 (2:20 pm)
I noticed my vision changes this winter after my yearly visit to ophthamologist, so scheduled a second visit which determined a significant change. Then was scheduled to another ophthamologist for 2nd opinion, and he said the vision problem was not correctable with lenses, and that I should see a neuro ophthamologist (only 1 in Maine, but new in her field). I chose to get a referral to Mass Eye & Ear with Dr Dean Cestari (one of the very few having board certification in both ophthamology and neurology), but can’t see him til November. Vision is very blurred, and is now 20/50 (or is it 50/20?} … anyway, what others see at 50 feet is what I see at 20 feet. Yesterday I spoke with someone who mentioned 3 people they knew locally whose vision has changed since they were diagnosed with Lyme. Have requested a broad range of Lyme testing , to include PCR, from my PCP. By the way, I had 11 imbedded ticks removed this year … my husband is becoming a pro at this! We live in Warren Maine, in the most densely tick infested area of Maine. And no, I don’t want to move. Any other suggestions? Note: I had mitral valve replacement with St Jude valve 8/1/17 , so unable to have MRI.
Dr. Daniel Cameron
07/25/2018 (1:57 pm)
I am glad to hear you are including a tick borne evaluation.
Aaron Hylton
07/24/2018 (2:13 am)
My worst problem is by far debilitating eye pain and visual disturbances that no one can find any diagnosis for. My llmd did clinically diagnose me with Lyme and babesia but even he doesn’t know what to do about the extreme eye pain and such bad visual disturbances. I could write a book I have so many. I’m on iv rocephin which has seemed to help maybe just a few things a little so far just not my worst which is the eye pain and vision problems which has all but stopped my life. It’s gotten so bad I had a second mri, have had a ct, been to many eye specialists including a neuro op, and no one can see what is causing the eye pain. Can lyme do this and it not be visible in any way to the dr.s? And is there anything you would recommend that might would help to get me out of this torment. Even the other neuro problems have gotten better besides head pressure at times and ears always clogged and fluid always on my ears in the mornings. Any help is appreciated more than you know. Thank you and God bless
Dr. Daniel Cameron
07/24/2018 (7:41 am)
I am sorry to hear how many eye problems you are having. It is common in tick borne illnesses to improve in some areas but not so much in other areas. I also bring in a broad range of specialists targeting the more severely affected areas to rule out other problems. I can’t comment on whether there are any options overlooked without an evaluation. We need more doctors to take on the challenge.
JEFF
07/24/2018 (2:02 am)
https://FoxVisionDevelopment.com/
https://www.covd.org/