Can Lyme Disease Affect the Eyes? Uveitis, Blurred Vision, and Eye Symptoms

Lyme disease can occasionally affect the eyes
Symptoms may include blurred vision, eye pain, floaters, and redness
Prompt evaluation may help prevent lasting visual complications

Lyme disease is commonly associated with flu-like symptoms, joint pain, and neurologic complications, but an infection with Borrelia burgdorferi can also affect the eyes. Lyme disease eye symptoms may include blurred vision, eye pain, redness, floaters, light sensitivity, double vision, optic nerve inflammation, or uveitis.

These symptoms are not specific to Lyme disease and can occur with many other ophthalmologic, infectious, inflammatory, or neurologic conditions. New or worsening visual symptoms should therefore be evaluated promptly, particularly when there has been possible tick exposure or travel to a Lyme-endemic area.

How can Lyme disease affect the eyes?

Reported ocular manifestations of Lyme disease include:

• Blurred or reduced vision
• Eye pain or redness
• Floaters
• Light sensitivity
• Double vision
• Conjunctivitis
• Keratitis
• Optic neuritis
• Uveitis
• Dryness or incomplete eye closure associated with facial nerve palsy

Ocular involvement is considered uncommon, and establishing that Lyme disease is responsible can be difficult. Clinicians must consider the patient’s symptoms, examination findings, exposure history, laboratory results, and other possible causes.

For a broader discussion of visual and neurologic manifestations, see Lyme disease symptoms and optic neuritis associated with Lyme disease.

Uveitis and Lyme disease

Uveitis is inflammation involving the middle layer of the eye. It may result from infections, autoimmune or inflammatory conditions, trauma, medications, or other causes. Although both Lyme disease and syphilis can affect the eyes, uveitis is an uncommon manifestation of either infection.

Diagnosing and treating uveitis promptly is important because ongoing inflammation may place a patient at risk for impaired vision. Treatment depends on the underlying cause and may include antimicrobial therapy, anti-inflammatory eye drops, systemic corticosteroids, or other ophthalmologic treatments.

In their article, “Co-infectious Uveitis With Syphilis and Lyme Disease: A Case Report,” Mandal and colleagues describe what they believe was the first documented case of a patient with positive testing for both syphilis and Lyme disease who developed uveitis.¹

Case report: Uveitis with Lyme disease and syphilis

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

A few weeks earlier, she had developed rashes on her palms, the soles of her feet, and her torso. She did not recall a tick bite.

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

An ophthalmologic examination confirmed panuveitis without macular edema or vasculitis. She began treatment with corticosteroid and atropine eye drops, but her symptoms did not improve.

A few days later, she developed a fever, sore throat, and generalized lymphadenopathy. She also reported a history of hepatitis C, for which she had last received treatment one year earlier.

“To determine the underlying cause, a serological test for Borrelia and syphilis was conducted,” the authors state.

Testing was positive for both Lyme disease and syphilis. Because both infections were identified, the report could not determine with certainty how much each infection contributed to the patient’s ocular inflammation.

The woman was treated with intravenous penicillin and oral doxycycline. By the time of discharge, her symptoms had partially improved.

Authors conclude:

• “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 a 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, this patient responded well to three weeks of oral doxycycline.”
• The authors also noted that recurrence has been reported following treatment of Lyme-associated uveitis and that some patients may require additional antibiotic treatment.

Case report: Lyme disease affects the eyes of a 10-year-old boy

After vacationing in an area endemic for Lyme disease, a 10-year-old boy developed sharp, bilateral eye pain, blurred vision, and increasing redness in both eyes over a 3-day period. He did not recall a tick bite.

Three months before presentation, he had experienced mild, intermittent redness of the eyes without pain.

One month before his eye symptoms worsened, the boy developed “a brief generalized illness with fevers, headache, and cervical/post-cervical and submandibular lymphadenopathy,” the authors report.²

An ophthalmologic examination and laboratory testing led to a diagnosis of Lyme-associated uveitis.

“Early identification of Lyme-associated uveitis is crucial to initiate appropriate treatment and prevent long-term complications,” the authors state.

“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 was treated with a two-month course of doxycycline together with a prednisone taper. His symptoms resolved completely, and follow-up examination showed no remaining signs of intraocular inflammation.

Authors conclude:

• “Lyme-associated uveitis, though uncommon, can lead to serious complications.”
• “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.”

Frequently Asked Questions

Can Lyme disease affect the eyes?

Yes. Although uncommon, Lyme disease can involve the eyes. Reported manifestations include blurred vision, eye pain, redness, floaters, light sensitivity, optic neuritis, conjunctivitis, cranial nerve abnormalities, and uveitis. Because these symptoms have many possible causes, a prompt ophthalmologic evaluation is recommended.

Can Lyme disease cause blurry vision?

Yes. Blurred vision has been reported in patients with ocular Lyme disease, including those with uveitis or optic nerve involvement. However, blurred vision is not specific to Lyme disease and requires careful evaluation.

Can Lyme disease cause eye floaters?

Floaters may occur when inflammation affects structures within the eye, including in patients with uveitis. Many non-Lyme eye conditions can also produce floaters, so persistent or new floaters should be evaluated by an eye specialist.

Can Lyme disease cause blindness?

Permanent vision loss is uncommon, but delayed recognition and treatment of significant ocular inflammation may increase the risk of lasting visual impairment. Early diagnosis and appropriate treatment offer the best opportunity for recovery.

Clinical Takeaway

Eye involvement is an uncommon manifestation of Lyme disease but should remain in the differential diagnosis for patients with unexplained uveitis or other ocular inflammation, particularly when there is compatible travel or tick exposure. Because ocular symptoms have many possible causes, diagnosis should be based on the overall clinical picture rather than laboratory testing alone.

Prompt recognition and appropriate treatment of ocular Lyme disease may reduce the risk of long-term visual complications and improve patient outcomes.

Related Articles

Learn more about other visual and neurologic manifestations of Lyme disease:

Vision problems in a patient with Lyme disease and giant cell arteritis
Visual changes due to Lyme disease
Can Lyme disease cause vision problems?
Can Lyme disease cause Bell’s palsy or facial palsy?

References

1. 1. Mandal S, Tayyab H, Mandal SC, et al. Co-infectious Uveitis With Syphilis and Lyme Disease: A Case Report. Cureus. 2024;16(4):e58608. doi:10.7759/cureus.58608.
   2. DesLauriers A, Larochelle M. Lyme Disease-Associated Uveitis: A Case Report and Review Emphasizing the Importance of Travel History and Geographic Considerations. Moran Clinical Ophthalmology Resource for Education (CORE). Published August 9, 2023.

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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