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.
Caroline
06/30/2019 (9:01 pm)
Dr. Cameron – I have Chronic Lyme and have been diagnosed with Ocular Rosacea. Do you know if there is a link? I have searched the Internet. Any insight would be very helpful. Thank you.
Dr. Daniel Cameron
06/30/2019 (11:13 pm)
I sorry I can’t offer any additional insight. I typically have to rely on other findings to treat Lyme disease. I also have too include a ophthalmologist during follow-up.
Beth
06/15/2019 (12:45 pm)
My 9 year old grandson was diagnosed with Lyme and it presents in his eyes with retinal detachment. The only thing that helps is steroids! If lower the dosage the pain comes right back. We have no idea what to do. We are in Illinois but would travel anywhere if someone can help him.
Dr. Daniel Cameron
06/15/2019 (7:58 pm)
I am not an ophthalmologist. I posted the Lyme disease science video to share that there are doctors looking into the problem.
Kathy Hedrick
01/25/2020 (12:10 pm)
Hi. Thank you for this insight. I have Lyme disease which was diagnosed after I woke up one morning and couldn’t see. Went to optometrist first who admitted my case was over his head, he sent me to a wonderful ophthalmologist who I’ve been treating with last 3 years. My vision the first time I saw her was legally blind 20/200. I have chronic inflammation/uveitis in both eyes. Where can I find the video you mentioned you posted so I can show her ? My vision is better but we are having to control the inflammation with NSAIDs daily now and lots of prescription drops I use during flare ups. Spent a year on different drugs and steroids to get the inflammation down before we switched to NSAIDs.
Dr. Daniel Cameron
01/25/2020 (1:43 pm)
I am sorry to hear you still have problems after treatment for Lyme disease. I often have Lyme disease patients with eye problems. I reviewed and shared the paper in a blog. I advise my patients to consult an ophthalmologist. I also look a second time at Lyme disease. BTW the blog did not have a video.
Michael
12/03/2022 (4:58 pm)
That is scary. I had a severe Lyme flare-up 5 weeks ago. Three times now, I’ve woken up after several hours with my right eye very dry and very blurry. It does return to normal but takes an hour or two. It’s so recent and so disconcerting that I sleep with a timer to wake me up every hour or hour and a half to put drops in, so it doesn’t dry out. I start out with a drop of glycerin in each eye and immediately close my eyes. This seems to keep them lubricated. If I go more than that, the same might occur and I just don’t like it. Since it only just begun with the Lyme flare-up, I’m positive that’s what’s caused it and am convinced that it will resolve, once I’m over the flare-up. I’m very actively treating it with natural herbal anti-biotics and am finally feeling like it might be starting to turn around. I’m very hopeful. I’d like to get a good night’s sleep without having to wake up purposely to avoid the blurry vision.
Dr. Daniel Cameron
12/04/2022 (8:39 am)
I have patients who were not able to resolve their dry eyes after working with opthamologists. Their eye condition was resolved with antibiotics. I hope you do well with treatment for Lyme disease. I advise my patients not to overlook traditional antibiotics.
DANIEL GARRANT
05/04/2019 (7:30 pm)
I had lyme disease in my mid teens n sorry to say it reappeared again in my early 50’s. my eyesight has been affected this time as well as severe burning feet n joints. also have severe skin excema. back to my teens, when I whent into the marines, they treated me all the way through with a antibiotic that kept my ass hurting all the 13 weeks I was there. like I said now its back with a veangence. wish I could remember the name of the shot they gave me. danie; garraNT
RayR
04/02/2019 (12:14 pm)
Doctor Cameron
I have bi lateral peri-orbital edema with episcleritis. I’ve seen neuro ophthalmologists, immunological ophthalmologists along with a conjunctiva biopsy. The biopsy formed a pyogenic granuloma. I had mentioned LASIK surgery but was given a stern warning against since I had an underlying issue which produced the granuloma. A cousin with diabetic retinopathy had LASIK of which I suggested she get a second or third opinion. The LASIK was not successful.
A diagnosis for my decade long illness has been elusive but I plan on making an appointment with you as soon as I can secure transportation. Shoulder surgery about a year ago in which I was given ancef (sp) and vancomycin during & after surgery seemed to have a significant effect more so on my right eye, I may have actually herxed two days after, both of which never happened before when I first pursued Lyme with various rounds of AB’s. It is why I think and hope a revisit of this issue will be beneficial. Forgive the comment as I only have a BS after my name but when I read someone contemplating LASIK I thought I’d relay what I was told. Perhaps you could further comment.
Thank you
RayR
Dr. Daniel Cameron
04/02/2019 (1:34 pm)
I often see ophthalmologic problems in my Lyme disease patients. I encourage my patients to also continue their care with their ophthalmologist.
Mom
02/09/2019 (3:15 pm)
Dr. Cameron-
My son had been growing on the projected angle on his chart but then stopped growing in height. He has been tested by IGenX and also the CDC test positive for Lyme, Bartonella & Babesiosis. Could these deseases by stunting his growth? My child’s doctors wonder but say they haven’t any information on how children’s growth is effected by lyme and coinfections. I believe he has had it for several years undetected. Maybe from 7 years old when I saw his fine motor skills in his handwriting going down when they should have been improving. He was hit in the face by a baseball in Little League the next year, dropped out of baseball. He was diagnosed with binocular vision problems by Dr. Liu in 5th grade after she diagnosed his sister. It wasn’t until high school that I heard about Dr. Padula. He dx the lyme bio markers confirmed by IGenX blood test. I am concerned as I am quite tall. For quite a while my son was in the 90th percentile of children his age for height but now hasn’t been thriving for a few years. He is now on the low end of normal said an Endocrinologist? What can be done to help him to grow. He is 17. Could the Lyme and Coinfections caused this? His father keeps telling him there is nothing wrong with him and discourages him from following his antibiotics. This is not helpful at all. Please what can be done? You are in New York, do you have evening hours or weekends? Is there a Lyme literate MD nearer to central CT that you would recommend?
Dr. Daniel Cameron
02/11/2019 (12:27 am)
How frustrating. Call my office in New York at 914 666 4665 with questions.
Julie Schubkegel
03/22/2022 (8:05 am)
Hello Dr Daniel Cameron, I have had Lyme for about 10 years, I have had multiple issues with eye infections, but today I ended up with one pupil fixed and dilated and one normal. Have you ever heard of that with Lyme? The condition is anisocoria. Common in people with syphillus. I went through all testing in the ER, scans MRI, but they found nothing wrong… just wondering what you thought.
Dr. Daniel Cameron
03/23/2022 (7:04 am)
There are many causes of anisocoria, Reversible Horner’s syndrome has been described in Lyme disease. https://collections.lib.utah.edu/details?id=226339