Lyme Disease Can Affect Your Eyes Leading to Various Complications

Lyme disease is typically associated with flu-like symptoms or neurologic complications, but infection with Borrelia burgdorferi can also cause problems with your eyes.

In their article, “Co-infectious Uveitis With Syphilis and Lyme Disease: A Case Report,” Mandal and colleagues describe what they believe is the first documented case of a patient with concurrent co-infection of syphilis and Lyme disease who developed uveitis—an inflammation of the middle layer of the eyeball.

Uveitis is caused by infections, autoimmune conditions, and trauma. Although Lyme disease and syphilis have been known to impact the eyes and cause complications, these infections typically do not cause uveitis.

Diagnosing uveitis and treating it promptly are imperative, since patients are at risk for vision loss. Patients with severe eye complications are typically treated with tetracycline or beta-lactam antibiotics with or without steroids.

Case Report 1: Adult Woman With Co-Infection

A 45-year-old woman was admitted to the emergency department with severe bifrontal headache associated with left eye pain and blurred vision in the right eye with floaters and clear fluid oozing from both eyes.

A few weeks earlier, she developed rashes on her palms, the soles of her feet, and torso. There was no known history of tick bites.

The patient did not have any typical symptoms related to Lyme disease or syphilis on initial presentation.

Laboratory testing confirmed the diagnosis of panuveitis without macular edema or vasculitis, and the woman began treatment with steroids and atropine eye drops.

However, her symptoms did not improve.

A few days later, she developed fever, sore throat, and generalized lymphadenopathy. She reported having hepatitis C with the last treatment received one year earlier.

To determine the underlying cause, serological testing for Borrelia and syphilis was conducted. Test results were positive for both Lyme disease and syphilis.

The woman was treated with intravenous penicillin and oral doxycycline. At discharge, her symptoms had somewhat improved.

Case Report 2: 10-Year-Old Boy After Travel to Endemic Area

After vacationing in an area endemic for Lyme disease, a 10-year-old boy developed problems with his eyes, including sharp bilateral eye pain, blurred vision, and increased redness over a 3-day period. He did not report any tick bites.

Three months prior to presenting, he reportedly had mild, intermittent eye redness without any pain.

One month before the increase in eye problems, the boy experienced a brief generalized illness with fevers, headache, and cervical, post-cervical, and submandibular lymphadenopathy.

Examination and test results revealed he had uveitis due to Lyme disease.

Early identification of Lyme-associated uveitis is crucial to initiate appropriate treatment and prevent long-term complications.

This case illustrates the importance of maintaining a high suspicion for Lyme disease in patients with uveitis if there is a report of recent travel to Lyme-endemic areas.

The boy’s symptoms completely resolved following treatment with a 2-month course of doxycycline and a prednisone taper. Clinical examination showed no remaining signs of intraocular inflammation.

Key Clinical Insights

Although Lyme disease and syphilis screening is not routinely conducted for every case of uveitis, serology should be considered on a case-by-case basis when there is high suspicion of these infections.

Concurrent co-infection of syphilis and Lyme disease is an unusual occurrence and can be associated with poor visual outcomes if treatment is delayed.

Despite the preference for administering intravenous ceftriaxone in treating Lyme-uveitis, the adult patient responded well to three weeks of oral doxycycline.

Recurrence following treatment of Lyme-associated uveitis is common (four out of seven patients in reviewed cases) and may require second-line antibiotics.

Travel History and Geographic Considerations

Lyme-associated uveitis should be considered in any patient presenting with new-onset uveitis after travel to a Lyme-endemic area.

A detailed history should focus on possible exposure and any symptoms outside of eye-related issues, though ocular involvement can be the sole manifestation of Lyme infection.

Lyme-associated uveitis, though uncommon, can lead to serious complications including permanent vision loss if not recognized and treated promptly.

Frequently Asked Questions

Can Lyme disease cause eye problems?

Yes. Lyme disease can cause various eye complications including uveitis, conjunctivitis, keratitis, optic neuritis, and cranial nerve palsies affecting eye movement.

What is uveitis in Lyme disease?

Uveitis is inflammation of the middle layer of the eyeball (uvea). In Lyme disease, it can present as anterior, intermediate, posterior, or panuveitis and may be vision-threatening.

How is Lyme-associated uveitis diagnosed?

Diagnosis combines ophthalmologic examination, serologic testing for Lyme disease, clinical presentation, and exposure history. Not all cases of uveitis require Lyme testing, but it should be considered based on risk factors.

Can children get eye problems from Lyme disease?

Yes. The case of the 10-year-old boy demonstrates that children can develop Lyme-associated uveitis, particularly after travel to endemic areas.

Does Lyme disease eye involvement always improve with treatment?

Most patients respond to appropriate antibiotic therapy, though recurrence is common. Some patients may require extended treatment or second-line antibiotics. Early treatment is essential to prevent permanent vision loss.

Clinical Takeaway

Lyme disease can affect the eyes in multiple ways, with uveitis being a serious but treatable complication. Clinicians should maintain high suspicion for Lyme disease in patients with uveitis who have traveled to endemic areas or have exposure history. Early diagnosis and appropriate antibiotic therapy are essential to prevent vision loss and long-term complications.