Eye problems in tick-borne diseases other than Lyme

“Why should an ophthalmologist have a good understanding of Lyme diagnosis and treatment?” asks Sathiamoorthi [1], from the Mayo Clinic, in an article published in the Current Opinion in Ophthalmology. “Vision-threatening ophthalmic manifestations are relatively common in Lyme disease (LD) and Rocky Mountain spotted fever.”

by Daniel J. Cameron, MD MPH

“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,” she explains. While manifestations may be present with LD and Rocky Mountain spotted fever, ocular involvement is rare in other tick-borne diseases such as babesiosis, tick-borne relapsing fever, Powassan encephalitis, ehrlichiosis, anaplasmosis, and Colorado tick fever, Sathiamoorthi points out.

However, the true prevalence of ocular involvement due to tick-borne illnesses is unknown. Limitations with testing can make it difficult to identify patients. “It is crucial to know who is appropriate to test in order to avoid false positive results.” If an individual has been symptomatic for only a short period of time, they “may not have detectable serum IgM antibodies to the causative organism because it takes time for this immune response to develop.”

It can also be difficult to determine the cause of the ocular complaints if there is evidence of more than one tick-borne illness. “One case report [2] describes a patient with optic neuritis and orbital myositis who had serologic evidence of HME [Human Monocytic Ehrlichioisis], Borrelia burgdorferi, and Babesia,” cites Sathiamoorthi.

There are more than one species of ticks associated with ocular findings, as well. According to Sathiamoorthi, those include Ornithodoros genus, Dermacentor variabilis Ambylomma americanum, Ixodes scapularis, and Dermacentor andersonii.

Sathiamoorthi advises doctors to “carefully generate a reasonable differential based on clues in the medical and social history regarding exposures and risks.”

“Patients who are most likely to have ophthalmic Lyme disease,” explains Sathiamoorthi, “are those with ocular manifestations commonly associated with Lyme disease (i.e. Bells palsy, cranial nerve palsies and keratitis); tick exposure in Lyme endemic regions; other signs/symptoms of late Lyme disease (i.e. inflammatory arthritis, carditis, acrodermatitis chronica atrophicans rash, encephalopathy and meningitis); and negative syphilis testing.”

Read more on eye problems in tick-borne diseases in A growing list of eye problems in Lyme disease.”



1. Sathiamoorthi S, Smith WM. The eye and tick-borne disease in the United States. Curr Opin Ophthalmol. 2016;27(6):530-537.
2. Pendse S, Bilyk JR, Lee MS. The ticking time bomb. Surv Ophthalmol. 2006;51(3):274-279.

8 Replies to "Eye problems in tick-borne diseases other than Lyme"

  • smithwaugh
    11/15/2023 (1:40 am)

    The fact that tick-borne diseases can affect the eyes in various ways is both concerning and enlightening. Your detailed exploration of these ocular manifestations not only raises awareness but also emphasizes the importance of recognizing symptoms beyond the typical manifestations of tick-related illnesses.

  • Kristine Kellas
    03/21/2022 (11:07 am)

    My husband is desperate for answers regarding his permanent vision loss in one of his eyes (he is 39 years old, non-smoker, in great physical shape, doesn’t drink or so drugs). He has had chronic Lyme and Erhlicosis (he was hospitalized). He is mostly outdoors for work and gets bit regularly. He has seen multiple doctors with no answers—they are at a loss because all the testing comes back normal. He is in chronic eye pain, eye pressure, chronic headaches, blurry vision (separate from his eye loss), and heart palpitations. Lyme testing comes back low levels. I know erhlicosis can cause blindness in dogs but are there studies showing it can affect the optic nerves in the eye causing blindness in humans?

  • Medina
    07/24/2021 (9:22 am)

    I have ocular toxoplasmosis has anyone ever tested you for this?

    • Dr. Daniel Cameron
      07/24/2021 (10:05 am)

      Toxoplasmosis can cause problems in HIV disease. I have not seen any work on whether toxoplasmosis is a problem for Lyme disease patients.

  • John Lancaster
    05/17/2021 (3:52 pm)

    My eyes are sensitive to light is this a problem many people complain about.

  • Glenda Vandiver
    08/03/2020 (9:59 am)

    I have made to have shots in my eye plus eye surgery. We are trying to save my eye. I had two Lyme test come back negative. And I have been sick off and on all year. With things never happened to my body before. They cannot find out the source of this infection. I know I have line that I cannot get them to listen to me. What can I do if my test keep coming back negative

    • Dr. Daniel Cameron
      08/03/2020 (7:27 pm)

      There are so many causes for eye problems beyond Lyme disease. Your doctor will have to use clinical judgment to determine whether to treat for Lyme disease if the test are negative.

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