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.
Expertans.Com
03/13/2020 (3:37 pm)
Summary:Knowledge of systemic and ophthalmic manifestations combined with an understanding of the epidemiology of disease vectors is crucial for the diagnosis of tick-borne diseases.
Laurie B
08/15/2019 (3:29 pm)
I was diagnosed with Lyme disease just 2 weeks ago confirmed by blood test. I am in the headache phase but woke up with my left eye a broken blood vessel and blood in my eye. Not sure if it means anything or not. This disease scares me, I have the fatigue, excessive joint pain and now headaches. I went to the dr a month ago because my lymp node in my groin was extremely swollen I had fever and chills – got antibiotic but then a rash on my leg and then she tested me for Lyme Disease, I did have a tick attached a few months ago.
I am wondering though if it was before that. I was having balance issues 3 months ago, she sent me to a Neurologist and I went through testing, I had a small amount of Swelling around the brain, and did many nerve tests and was given the diagnosis of “Disorder of the autonomic Nervous system”. Then because of a B12 deficiency they started me on B12 Shots Weekly 2 months ago.
Now to find out I have Lyme disease, I assume it is all connected but the eye issue is kind of scary to me. What can it mean?
Dr. Daniel Cameron
08/15/2019 (11:19 pm)
Lyme disease can lead to problems with the autonomic nervous system.
Katie
02/18/2020 (11:43 pm)
I no longer have Lyme but have now been diagnosed with multiple co-infections including Bartonella, babeosis, Ehrlichia, anaplasma, etc. A few years ago, while going for Lasix, multiple retinal occlusions (small blood clots?) were found. No explanation whatsoever..
I know in my bones it is related to the Lyme/confections i have had for ten years.
maria
08/16/2020 (9:51 am)
Hi Katie!
This is the fist time ever I have heard of anyone being cured of lyme, but still with co infections. How do you know you do not have lyme (borrelia). Did you do igenex testing or something else?
Dr. Daniel Cameron
08/17/2020 (8:01 am)
We need a test to determine when Lyme disease has cleared. I have patients who feel remain well. They are reluctant to use the word cure given how severe there original illness was.
Colin
09/07/2020 (3:55 pm)
Laurie B. You probably do have Lyme disease. A simple 2 pills a day (Doxycycline Hyclate 100mg) twice daily for a month will cure the immediate issues but your eyes are more critical see, https://globallymealliance.org/about-lyme/prevention/other-tick-borne-diseases/ which suggest you may also have (BARTONELLA HENSELAE) See ‘Global Lyme alliance’. This Can be Quite serious. Find a good younger Dr. or go to your Hospital asap.
Tammy H
07/02/2019 (5:42 pm)
I was diagnosed with third stage Lyme in 2005, with floaters, Retinal vasculitis and cotton wool spots. I healed quickly with doxycycline, and have been on Amoxicillin since then daily. About once a year I get a flare up of the vasculitis, and I’m developing worsening side affects from the doxycycline which I take for about a month with each flare up. Is there another antibiotic that would work just as well, without the sun sensitivity?
Dr. Daniel Cameron
07/03/2019 (12:13 am)
There are other options. You should discuss these options with your doctor.
Keith
10/27/2020 (3:51 pm)
With the medication did the eye floaters go away?