Can Tick-Borne Diseases Other Than Lyme Affect the Eyes?
Most tick-borne diseases rarely affect the eyes
Lyme disease and Rocky Mountain spotted fever are most often involved
Prompt evaluation is important for vision changes
Tick-borne diseases can occasionally affect the eyes, although these complications are uncommon. Lyme disease is the tick-borne infection most frequently associated with ocular manifestations, but several other infections have also been linked to inflammation involving the optic nerve, eye muscles, retina, or cranial nerves.
Recognizing these rare manifestations can help guide diagnostic testing and treatment, particularly when eye symptoms develop after a tick bite or possible exposure in an endemic region.
According to Sathiamoorthi and Smith, “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.”
Their review summarizes the tick-borne infections most likely to produce ophthalmic complications in the United States.
While ocular manifestations have been reported with Lyme disease and Rocky Mountain spotted fever, the authors note that eye involvement is uncommon in other tick-borne illnesses, including babesiosis, tick-borne relapsing fever, Powassan virus encephalitis, ehrlichiosis, anaplasmosis, and Colorado tick fever.
However, the true prevalence of ocular involvement from tick-borne diseases remains unknown. Diagnostic testing has important limitations, making it difficult to determine how frequently these infections affect the eyes.
Sathiamoorthi emphasizes that appropriate patient selection for testing is essential to reduce false-positive results. Patients who have been symptomatic for only a short period may not yet have detectable IgM antibodies because the immune response takes time to develop.
Diagnosing the cause of ocular symptoms can become even more challenging when patients have evidence of multiple tick-borne infections. Sathiamoorthi cites a case report describing a patient with optic neuritis and orbital myositis who had serologic evidence of human monocytic ehrlichiosis, Borrelia burgdorferi, and Babesia infection.
Several tick species have been associated with ocular manifestations of tick-borne disease. According to Sathiamoorthi, these include Ornithodoros species, Dermacentor variabilis, Amblyomma americanum, Ixodes scapularis, and Dermacentor andersonii.
Because ocular findings are often nonspecific, Sathiamoorthi advises clinicians to develop a thoughtful differential diagnosis based on the patient’s medical history, travel history, environmental exposures, and risk of tick bites.
Patients most likely to have ophthalmic Lyme disease include those with Bell’s palsy, cranial nerve palsies, keratitis, and tick exposure in Lyme-endemic regions.
Additional clues may include inflammatory arthritis, Lyme carditis, acrodermatitis chronica atrophicans, encephalopathy, meningitis, and negative syphilis testing.
For additional information on Lyme-related eye conditions, see A Growing List of Eye Problems in Lyme Disease.
Frequently Asked Questions
Can babesiosis affect the eyes?
Eye involvement from babesiosis appears to be rare. Most published reports involve isolated case reports or patients with coinfections, making it difficult to determine whether Babesia alone caused the ocular findings.
Which tick-borne diseases can affect the eyes?
Lyme disease and Rocky Mountain spotted fever have the strongest published associations with ocular complications. Other tick-borne infections, including ehrlichiosis, anaplasmosis, Powassan virus disease, babesiosis, and tick-borne relapsing fever, have only rarely been associated with eye involvement.
Should vision changes after a tick bite be evaluated?
Yes. New blurred vision, double vision, eye pain, loss of vision, or other unexplained eye symptoms following a tick bite or suspected tick-borne illness warrant prompt medical evaluation.
Clinical Takeaway
Although Lyme disease remains the tick-borne infection most frequently associated with ocular complications, clinicians should recognize that several other tick-borne diseases have also been linked to eye involvement. Careful clinical assessment, appropriate laboratory testing, and consideration of possible coinfections are important when evaluating patients with new eye symptoms after tick exposure.
Although uncommon, eye symptoms following a tick bite or suspected tick-borne illness deserve prompt evaluation because early diagnosis may help preserve vision and identify the underlying infection.
Related Articles
A Growing List of Eye Problems in Lyme Disease
Lyme Neuroborreliosis
Lyme Disease Coinfections
Babesia and Lyme Disease
References
- Sathiamoorthi S, Smith WM. The eye and tick-borne disease in the United States. Curr Opin Ophthalmol. 2016;27(6):530-537.
- Pendse S, Bilyk JR, Lee MS. The ticking time bomb. Surv Ophthalmol. 2006;51(3):274-279.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
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
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.
My eyes are sensitive to light is this a problem many people complain about.
I have ocular toxoplasmosis has anyone ever tested you for this?
Toxoplasmosis can cause problems in HIV disease. I have not seen any work on whether toxoplasmosis is a problem for Lyme disease patients.
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?
I have not seen permanent vision loss in my patients. I wrote the following blog from a published case. https://danielcameronmd.com/lyme-disease-vision-problems/
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.