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.
Dale Mock
02/02/2019 (4:48 am)
As a an allopathic MD for many years, I have been studying the Lyme Disease and it’s Spectrum disorders, and would suggest, (though highly controversial, and absolutely verboten by the FDA and other PTB) consideration being given to the off label use of Stevia (to break down biofilms) and Colloidal Silver, as a germicidal to eradicate the Lyme spirochete. This disorder–Lyme–and it’s syndrome and–syphilis–and it’s syndrome are quite similar in their manifestations. Both are spirochete type disorders. Silver and other heavy metals were long used for control of syphilis, and seemed to do well up until the advent of antibiotics (Penicillin), but then fell by the wayside. One should be watchful for the development of possible Herxheimer reaction.
Then with the advent of the “blue man”, the FDA ( read “better living” through governmental interference and stupidity) stopped the use of colloidal silver was curtailed without further study nor research. Turns out that when the “blue man” was studied, he was using a silver solution, which was no where near the make-up, and chemistry of colloidal silver, and despite his looks was pretty healthy and did not die of silver poisoning.
Liz Richardson
01/25/2019 (11:15 pm)
About 11 years into my Lyme Disease, I developed a four-layered macular pucker. This was 6 yrs ago and my eye surgeon and ophthalmologists were not Lyme literate and would not make a connection. Since then, I’ve been trying to find any research that I can bring to their attention regarding this kind of eye condition. The closest I’ve come so far is a brief mention of research exploring a link between bartonella hensalae and macular pucker. Have you come across any information relating to macular pucker as an ophthalmic manifestation of tick-borne disease. I’m an American living in the Scottish Highlands, where I acquired my Lyme Disease. I don’t know if that makes any difference, I know we have different strains here.
Dr. Daniel Cameron
01/26/2019 (1:26 am)
I have seen a wide range of eye findings in my patients. I often need to refer them for a ophthalmologist evaluation. I reviewed the article in a blog to share what I learned from the article and to encourage other articles. I have not seen a macular pucker in my practice
Danielle
11/04/2018 (9:42 am)
My mother is having macular problems and has been told her options are steroids or laser she is still on her antibiotocs for lyme…shes 3 months on them now but our fear is that the steroids might make the lyme worse?
Dr. Daniel Cameron
11/05/2018 (9:27 am)
I find eye problems are common in my practice. I included my Lyme disease science blog of an article on eye problems to encourage a conversation and more research. It can be difficult when steroids are needed for one problem yet we try to avoid in Lyme disease. I hope treatment for Lyme disease will help.
Leanne O'Donnell
11/04/2018 (7:38 am)
My husband cant get a possitive Lyme test in New Zealand even though My daughter and I did. his eye are almost blind now. Cant do anything about it. Eye doctors are ignorant of Lyme too. very sad. I gave my doctor information from the internet but he scoffs at it.
I know not all doctors are jerks but the numbers climbing.
Anne
05/15/2022 (3:22 am)
Hi Leanne. Can I please ask WHERE in NZ you managed to get test done? THANKS
Becky Smith
09/27/2018 (9:47 pm)
I went undiagnosed with Lyme for 5 years until I figured it out. I received treatment and everything is pretty good except my eyes. I recently developed aniseikonia and demanded my eye doctor run tests and look at my retina. My vision is 20/20 so he figured he did not need to. He did…and we found a buldge on one of them, edema we think. I see an eye specialist in two weeks. I’m terrifed of steroid injectons because they are not good for us Lymies. You mentioned here that if steriod injections are needed an, antimicrobial regimen would be needed too. What exactly do you mean by that? Getting back on antibiotics after having been off for over a year? Blood breaking antibiotics? Thanks, any information would be helpful. Becky Smith