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]

 

by Daniel J. Cameron, MD MPH

The authors described patients with tick-transmitted diseases presenting with the following ophthalmologic findings:

  1. Follicular conjunctivitis
  2. Periorbital edema and mild photophobia
  3. Bell’s palsy, cranial nerve palsies and Horner syndrome
  4. Argyll Robertson pupil
  5. Keratitis
  6. Optic neuritis, papilledema, papillitis and neuroretinitis
  7. Myositis of extraocular muscles and dacryoadenitis
  8. Episcleritis, anterior and posterior scleritis
  9. Anterior, intermediate, posterior and panuveitis
  10. Retinal vasculitis, cotton wool spots and choroiditis
  11. 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 an 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]

Uveitis can be found 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 ocular findings, 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. …The opthamologist needs to be alert to the possibility of an infectious cause depending on the patient’s risk factors. The growing number of Lyme disease cases and other tick-borne diseases…should heighten clinical suspicion for tick-borne illness…”

 

References:

  1. 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.
  2. 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.
  3. Agrawal, R.V., et al., Current approach in diagnosis and management of anterior uveitis. Indian J Ophthalmol, 2010. 58(1): p. 11-9.

 


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Laurie B
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Laurie B

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… Read more »

Tammy H
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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?

Caroline
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Caroline

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.

Beth
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Beth

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.

DANIEL GARRANT
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DANIEL GARRANT

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
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RayR

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… Read more »

Mom
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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… Read more »

Dale Mock
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Dale Mock

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… Read more »

Liz Richardson
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Liz Richardson

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… Read more »

Danielle
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Danielle

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?

Leanne O'Donnell
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Leanne O'Donnell

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.

Becky Smith
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Becky Smith

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… Read more »

Kelly stanford
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Kelly stanford

I have been diagnosed with lyme. I got bit on June in arkansas. Long story short this is my third round of antibiotics. But just 2 days into my 3rd round of cefuroxime my eyes are so painful and so painful to blink. They r somewhat bloodshot. But it is the pain that I’m concerned about. They were sort of matted this morning. I’m going to a llmd so just ur Opinion thanks

Marine
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Marine

Hello. I’ve had lyme disease undetected at the age of 11, but was diagnosed at age 15. I have many health related issues due to Lyme. The right side of my face feels slightly stiff and there is slight drooping of the right eye. Recently, I noticed that my right eye seems to be smaller than the left. Is this a side effect of the Lyme as well? Is there a name for this symptom? Is it reversible? It’s very distressing and affecting me greatly.

Cynthia
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Cynthia

I noticed my vision changes this winter after my yearly visit to ophthamologist, so scheduled a second visit which determined a significant change. Then was scheduled to another ophthamologist for 2nd opinion, and he said the vision problem was not correctable with lenses, and that I should see a neuro ophthamologist (only 1 in Maine, but new in her field). I chose to get a referral to Mass Eye & Ear with Dr Dean Cestari (one of the very few having board certification in both ophthamology and neurology), but can’t see him til November. Vision is very blurred, and is… Read more »

Aaron Hylton
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Aaron Hylton

My worst problem is by far debilitating eye pain and visual disturbances that no one can find any diagnosis for. My llmd did clinically diagnose me with Lyme and babesia but even he doesn’t know what to do about the extreme eye pain and such bad visual disturbances. I could write a book I have so many. I’m on iv rocephin which has seemed to help maybe just a few things a little so far just not my worst which is the eye pain and vision problems which has all but stopped my life. It’s gotten so bad I had… Read more »

JEFF
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JEFF
Vicki
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Vicki

I used to have perfect eye sight.
All of a sudden I was seeing black floaters and my short vision was declinimg. I was squinting in th4 glare. I developed astigmatism, droopy eye lids, conjunctivitis, dry eye, watery eyes.
Now my eyesight has gone to-3.75 and -3.50. I can’t wear contacts.
I got told this was all normal for a 47 yr old woman. ALSO told I couldn’t get laser to correct the issues.
Business is my biggest issue and judging distance especially in the evening.
Do you have any comments or suggestions.
Kind regards

Dianne
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Dianne

I have been told to stay away from any shape or form of steroids if you have or possibly have Lyme!

Jane Howard
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Jane Howard

Can you please tell me why you have to stay away from steroids if you have lyme. I have been using prednisolone drops for my eyes for posteria uveitis for over 2 years. I found out I have had lyme for at least a year. Thanks

GG
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GG

My 7yo son and I both have Bartonella henselae. He also has Lyme. I’m waiting on further Lyme testing for me. We are both on antibiotics for Lyme/Bart (and he is on monthly ivig temporarily to boost his immune system after Lyme destroyed it). He has had floaters, light sensitivity and worsening blurry vision since August 2017. He was diagnosed and on Lyme specific antibiotics in Jan 2018. I started feeling symptoms in March and had light sensitivity and blurry vision but got on antibiotics quickly so my vision is very manageable. We’ve been to prism glass eye drs, developmental… Read more »

wendy
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wendy

I was told over the past 8 years…I may have had Lyme. all sorts of tests …can it cause you to see a tick….i wake up at night and in my vision I see a bug…and it looks like a tick everytime. Doesn’t happen that much….but this week, it happened twice. one doctor said he felt the Lyme went to my brain….a Lyme specialist in Flemington, nj tolsd me since I had been on many antibiotics over the yrs for sinus stuff, the lyme would be gone. how do you rid eyes and brain of Lyme? Too many symptoms to… Read more »

Maria Tinajero
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Maria Tinajero

My Boyfriend got antibiotic treatment to kill the Lyme and now his eyes bulge out when he puts pressure on his head. Can Lyme cause the eyes to bulge out and if so what is the cause? Is it because of the inflammation after the treatment or is it because there’s damage done to the eyes?

Victoria Richardello
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Victoria Richardello

My mom has suffered with eye problems for almost a year. Her doctors here said all tests came back negative; there was nothing wrong, only dry eye. She also constantly complained about being tired and having no energy and really acted depresssed. Well, I finally took her to Boston. There she was diagnosed with uveitis and cornea problems, in both eyes. The retina doctor did numerous blood tests and still could not find out what was causing the inflammation in the back of her eyes. They would not do anything for the corneas until the inflammation had gone down. She… Read more »

Anna
Guest

Nice post.

Wende
Guest

Thank you for you response and your research on this. I want to thank everyone else thats written about the effects on their eyes. I thought I was alone.

Wende
Guest

Hi Doctor Daniel, I lost some vision in my left eye, about 30%. I went to the eye doctor and he sent me to a retina specialist. He saw some swelling in my veins going to my retina. He sent me to have a MIR to see if i had a brain tumor or MS. He also sent me for a blood test. My MRI came back negative. My blood work show a false/positive for lyme, but the retina specialist had more testing done on my blood work and it came back positive. My doctors office called and asked if… Read more »

Fred
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Fred

I recently saw an ID doc at albany med and he literally told me that there has only ever been 1 true case of lyme disease in NY state and that I don’t have lyme, though i tested positive after having the antibodies for over 4 years. I feel how angry you must have been. I believe I’ve had untreated lyme for around 4 yrs. Neuromuscular issues, eye issues and color change, mood swings from hell, sever muscle weakness, chronic infections, complete loss of taste and much more. I was only treated with 3 weeks of doxy, and actually ended… Read more »

DIMAS
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DIMAS

Hi Dr, Daniel. I went through several specialist who did not know exactly what happened to turn my visa right dark. I did commented to the optometrist and he then suspected it was tick disease. this took in california and was positive result. I’ve heard from him to say that,. the vision will not come back. But I do not give up believing that there will be a solution later. every day I wake up in the hope that I will have my vision back later. i need help, if I can talk about what I can expect. Thank you… Read more »

Susan Anderson
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Susan Anderson

My relative has Lyme and has had lots of problems . Her eye Dr just told she has more shots spots on her eyes Started with one now in both eyes. Compared them to cigarette burns. Said they would watch them, is there a treatment for this condition?

kalle kolpi
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kalle kolpi

Please help me! Can round retinal holes be caused by Lyme-disease? The ophtalmologist i went to last week said i have round holes (he called them tufts) in the retina in both eyes. He said its a “genetic thing” and doesn’t require laser surgery because its very unlikely a retinal detachment will come from this. But is he able to see if these holes will stay like this or if they progress and get bigger or if i get more holes over time? Also a year before these holes were found i was examined by another ophtalmologist and before that… Read more »

Ruth F
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Ruth F

I was diagnosed with Lyme in 2014 and was told I most likely was infected several years earlier. My biggest symptom has been brain fog until last year at which point I had what I will call an episode of heat exhaustion which precipitated exacerbation of my symptoms and the immediate onset of visual issues such as floaters, static type vision, light sensitivity, headaches and auras that stay with me every day. Note, prior to this episode I had almost perfect vision. I am now being treated by an LLMD and am 2 months into antibiotic treatment. I would say… Read more »

Karen M
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Karen M

I had early cataracts in both eyes, developed after I got sick with very late stage Lyme and several other TBDs. I read that syphilis is on the differential diagnosis list for cataracts. Shouldn’t Lyme also be on that list? My cataracts started at 51, neither sister has them and my mother’s only began at 70 or so.

Gail Wheeler
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Gail Wheeler

Dr. Cameron, you were the first doctor I saw for lyme after my regular GP. I had lyme twenty years ago and seem to have “recovered” though one never knows. Every member of my family has been infected with lyme or other tick borne illness. Among them, there are a number of eye issues. My husband has Fuchs’ Dystrophy and my grandmother, who at the time of infection was quite elderly, lost her peripheral vision in the space of several weeks and then went totally blind. She died, in my opinion, from lyme complications and was never truly treated. My… Read more »

Adriana Galindo
Guest
Adriana Galindo

I have been diagnosed with acute lyme disease over a year ago. It was discovered when my left eye was hurting like sinus pressure so I went to see an eye doctor, there they diagnosed it as optic neuritis. That doctor admitted me into the hospital for IV steriods. But then referred me to a neuro ophthalmologist that did a Western Blot and found the lyme. Thing is, I feel like a lab rat. I haven’t been able to get off the predisone since being diagnosed over a year ago. I’ve went from 20 mg up to 80 mg when… Read more »

Kim
Guest
Kim

I’m wondering if you have had any luck getting off predisone. We are in the exact same situation. Would love to hear how you are doing now and what you have done in the past year since you posted this. Thanks

Donna Falcone
Guest

Hi Dr. Cameron,
Is severe eye dryness a condition you have seen or read about in Lyme patients? Might it be caused by medications taken to treat TBDs? What is your experience? Thank you for talking about ocular manifestations of TBDs.

Dr. Daniel Cameron
Guest

Dry eyes occur in Lyme disease but they also are common in other conditions. You should include an ophthalmologist in your evaluation.

Shannon Sparrow
Guest
Shannon Sparrow

I have late stage lyme. Not chronic anymore but still dealing with fatigue and muscle joint issues as well as eye problems. I get floaters now and my vision is so much weaker now. I am 41 so I guess my vision is naturally getting worse but it has gotten worse rapidly. Some of my first symptoms of lyme were chronic dry eye and oh..i t feel like I have sand under my eyelid in certain spots.

Thom
Guest
Thom

Hi,
Could it be a Sjogren disease instead?
Symptoms are perfectly matching.

Ketti Parente
Guest
Ketti Parente

My 7 year old daughter has experienced what we call “visual snow” for 2.5 years. Around her 5th birthday we discovered that she sees static all the time. We are not sure if it suddenly appeared the night she thought millions of bugs were flying around her room, or if she has always had this. Have you ever encountered any Lyme patients that dealt with something similar?

Dr. Daniel Cameron
Guest

There are a number of eye disturbances in Lyme disease that do not fall under a specific diagnosis. For example, there are often floaters that can increase in numbers. You should include an ophthalmologist as part of your evaluation.

Windy J Cumberbatch
Guest

I found this to be quite helpful. I have Chronic Lyme Disease and was recently diagnosed as having Macula Degeneration. It seems also each year my eyesight changes, now I know why. Thank you so much.
Windy J Cumberbatch
Lyme Disease Advocate

Deanna
Guest
Deanna

I have chronic Lyme disease and I have lost all of my peripheral vision in my right eye. After 2 years of eye care professionals all of who told me there wasn’t anything wrong with my eyes I finally found a Lyme literate eye doctor who at least acknowledges that there had been damage to my eyes.

Dr. Daniel Cameron
Guest

We are are grateful to the Mayo author for submitting a review of eye findings in Lyme and other tick borne illnesses.

Lizabella
Guest
Lizabella

How did you find a Lyme eye doctor please help?

Brenda Kahn
Guest

Please read Kristin Reihman’s book Life After Lyme. She was my doctor in Pennsylvania and helped me recover from a very severe condition due to long term undiagnosed Lyme. I still have issues to resolve but her protocols were extremely helpful in my recovery. Her book can be a bit overwhelming in all the options, but the truth about curing Lyme is it’s a three level ongoing protocol 1- killing bugs 2- detoxing 3- empowering your mitochondria to work at an optimal level. This can mean for example eating a paleo or a ketogenic diet , while you take antibiotics… Read more »

Lisa Marshall
Guest
Lisa Marshall

Brenda, did you have ocular issues as well that were resolved? How long did it take before you saw real results from the protocol? Thank you for sharing about her as well as her book. Looking into this.

Wendy
Guest

My dad has severe inflammatory eye problems. His doctor suggested a cornea transplant. It did not work the first or second time. Last year, while thinking about having a third transplant, he tried IV ozone per Italian research. After fifth treatment one of his eyes exploded with a severe staph infection. He was placed on ABX and after five months it settled down but doctor says he needs another cornea transplant. Too much scar tissue. I would like him to try IV ceftriaxone first – and anti parasite drugs. Is it worth it? Do you glean anything from the results… Read more »

Dr. Daniel Cameron
Guest

Sorry to hear hear father is having problems. These two blogs addressed a broad range of eye findings seen in Eyes. Kudos to the author for reviewing what we know and don’t know. Our office does not have an ophthalmology on staff and therefore cannot answer your question.

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[…] is a nice synopsis by Lyme expert Dr. Daniel Cameron of an article in Current Opinion in Ophthalmology on the growing […]

JenniQ
Guest
JenniQ

Hello Dr. Cameron, In 2006, I developed optic neuritis. I was quickly treated with IV steroids, since my ophthalmologist thought that I had MS. An MRI which was done later showed no lesions, but after the IV steroids, I became covered in rashes, had fever, extreme headaches, slurred speech, forgot words, couldn’t add or subtract, and couldn’t remember what I had just done. I went to more doctors, and all tests came back negative. I searched online for answers and finally concluded that I might have Lyme disease. Doctors told me that was not possible because there was no Lyme… Read more »

Dr. Daniel Cameron
Guest

I was reviewing the paper to better understand ocular issues for my patients. It can be difficult to tell the cause of optic neuritis. They may decide that two episodes of optic neuritis is enough to call it MS. You would have to work with your eye doctor and neurologist. You should also consider consultation with someone who has experience in Lyme disease.

Gary Barrett
Guest
Gary Barrett

I recently developed cataracts that came on quite suddenly. I’ve also been diagnosed with Fughs Syndrome (FS). Do you think FS in any way connected to Lyme or co-infections? I’ve been told that surgery for cataract surgery can be risky for people with FS and make things worse. Any thoughts on this, doctor?

Dr. Daniel Cameron
Guest

Fuchs’ dystrophy also known as Fuchs’ corneal endothelial dystrophy or FCED, is a slowly progressing corneal dystrophy that usually affects both eyes. I was reviewing the paper to allow me to better understand ocular issues for patients in practice. You would have to ask your eye doctor.

Dori
Guest
Dori

What can be done about it??? My lyme came back after a year of remission. First symptom was in eyes…went to my eye Dr who said it was the ” most impressive” follicular conjunctivitis she had ever seen. Treated me with 4 rounds of antibiotic/ steroid eye drops and 2 weeks oral antibiotics. It never resolved and 7 months later sent me to Emory University. I saw the head eye Dr who said it was either chylamedia or lyme and 2 weeks of antibiotics and I would be fine(not)….I am soooo done with Allopathic doctors. Ps…I have been using the… Read more »

Dr. Daniel Cameron
Guest

I am happy to year you have sought different opinions. I am sorry to hear not of the approaches have resolved your eye problems. I hope the article I reviewed and this blog encourage other doctors to study the issues.

Darryl
Guest
Darryl

Can you please explain your eye symptoms?