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In their report, the authors describe a 69-year-old man who was admitted to the emergency room in New York City complaining of a headache and double vision.
One month earlier, the man had been hiking in a rural area of New York. He did not notice a tick bite or rash. Two weeks later, he developed a headache, which “localized to the right occipital region, and gradually moved to his right orbit,” states Dixit.
Five days later, he had double vision when opening both eyes; however, if he covered his right eye his vision normalized. “Although Lyme is known to affect the neurological system it usually does not manifest in the extraocular muscles,” the authors state.
In another study, Sathiamoorthi from the Mayo Clinic points out that “Although ocular involvement can be self-limited, delays in diagnosis may result in vision impairment and even blindness.” [2]
The man’s physical exam revealed a left-sided cranial nerve 3 palsy. All other exam findings were normal. According to the authors, 75% of patients with Lyme-induced cranial neuropathy present with facial palsy. To the authors’ knowledge, this is the only case report involving the third cranial nerve.
[bctt tweet=”Lyme disease causes double vision in 69-year-old man. ” username=”DrDanielCameron”]
Serologic tests were positive by ELISA and the Western blot showed 5 out of 10 IgG bands. The man’s spinal tap was positive by ELISA but negative by the CSF-to-serum ratio. He was treated successfully with a four-week course of intravenous ceftriaxone.
“Although neuroborreliosis is commonly associated with facial nerve palsy,” Dixit writes, “it may account for otherwise unexplained neurological manifestations and warrants evaluation with lumbar puncture and CSF studies.”
Related Articles:
Lyme disease causes vision loss in 46-year-old woman
Eye problems in tick-borne diseases other than Lyme
References:
- Dixit A, Garcia Y, Tesoriero L, Berman C, Rizzo V. Diplopia: A Rare Manifestation of Neuroborreliosis. Case Rep Neurol Med. 2018;2018:9720843.
- 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.
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I have had lyme now ( or some form of it ,in it’ ) for over 30 years. I was told MS,Lou Ger, over active nerves ,floaters in my eyes, many more with the most used ,” it’s all in Your head”. My guestion is will lyme attack the whites of a persons eyes ? I have dark gray lines showing up in the whites of my eyes ,that a doctor told me the thinning of the white section and what I was seeing was the the inner eye. Also two years ago during an eye exam I lost the sight in my right eye for a period of about 5 min.’s The doctor told me it was normal. I have come to think there is nothing normal with lyme over the years. Ant ideas ?
I have had 3 blood test for lyme all come back negative have burning feet headache on and off,brain fog short term memory loss eye problems I feel like its lyme
What are the parallels between
neuroborreliosis and neurosyphilis?
Both are caused by spirochetes.
There are many parallels.
many
Your doctor will have to use clinical judgment
Your vision loss may have been an optical migraine. You will need to be seen to rule out a retinal tear. I am not familiar with the full spectrum of eye finding. I have reviewed the paper to share what I learned. You may want to include a doctor who works with Lyme disease for the entire picture.
I have tinnitus, double vision, and knee pain. I have been to my ophthalmologist, neurologist, ENT, and family doctor. I also had a MRI brain scan that all came out negative. I also have developed insomnia. After seeing your blogs I am now calling my family doctor to ask for a Lyme disease test which none have suggested I do live in upstate New York where Lyme disease is prevalent. I am happy that I found you. Oddly enough I am hoping the Lyme disease test is positive. What do you suppose the odds are that I have Lyme disease? Thank you.
I find other symptoms including tinnitus and knee pain helpful in identifying Lyme disease even if the tests are negative.
Sounds familiar
17 months blood work came back negative/ inconclusive
It turned out
LYME DISEASE
Keep on your doctors
My son has what we think is congenital Lyme, diagnosed in his 20’s. Symptoms of fatigue, anxiety, and attention issues all his life, and he started getting double vision before diagnosis, and then head pressure 24/7 in one spot a year or so later. I also have Lyme, and have head pressure but in a different spot, also 24/7. Could his double vision be caused by Lyme? He’s not treating at the moment, so this has been there for about 3 years now. Not sure if it’s unrelated, or could be related to Lyme.
There are a broad range of visual disturbance issues in patients in my practice. I will add a thorough evaluation for a tick borne illness on top of your ophthalmologist.
Do the nervous and vision symptoms disappear after successful treatment of the disease? Does the patient in this article have any symptoms?
“His diplopia resolved and he was asymptomatic two months after initiation of therapy.” wrote the authors. I have patients who remain ill after treatment.
I started having diploma symptoms in Winter 2018. After many visits with ophthalmologists and neurologists who pursued demyelinating causes I was tested and was positive for Lyme. After many courses of oral antibiotics the symptoms subsided. I’ve had a couple short reoccurrences (1-2 days) but I’ve now had it for a week+. The doctors I saw were never willing to say the symptoms were as a direct result of Lyme. What type of doctor should I be seeing?
I would typically consult with a doctor experienced in treating Lyme disease. I would also typically continue careful followup with any ophthalmologist or Neurologist my patient is working with. Call my office at 914-666-4665 if you have any questions.
I developed double vision in 2013. About two years later, I finally got tested for Lyme and was treated by you with oral antibiotics for about a year where my symptoms lessened a great deal. Since then I have had two additional Lyme screenings whereby one came up clean and another had two or three positives. Within the last two years the double vision has gotten much worse and is still in both eyes. My eye doc diagnosed it as conversion insufficiency and wanted me to try their therapy treatments. I did not due to cost, however, could this be Lyme? Since last seeing you I been diagnosed with psoriatic arthritis although I am seronegative for inflammation and the medications tried did not improve any symptoms. I have several autoimmune disorders as well, could this all still be related to Lyme?
I am glad you were successfully treated in 2013. I am sorry to hear you have developed eye issues. I would typically revisit a doctor experienced in treating Lyme disease again in addition to you current doctors. I hope you find an answer soon.
I was bitten by a nymph about 1 year ago and I too am experiencing the sam double vision problems and when I cover my right eye my
Vision corrects. I’m on the way for an MRI today if the brain and hope and pray that I get the right diagnosis.
I pray that you get the right diagnosis. I find patients with a tick borne infection other symptoms that help in the diagnosis.
This man is not the only case. I had a Partial 3rd nerve palsy of my right eye in 2018 and a 4th nerve palsy on the right in 2021. Diagnosed with Lyme after that by a Functional doc. Infectious disease clinic declined to see me because conventional lab test was negative. Thank goodness for doxycycline (cleared my vision in 3 days after we doubled my initial dose) and functional medicine docs!! Reach out to me, Dr. Cameron, if you want any more about my story. My Neuro-ophthalmologist had no idea Lyme could cause this. Word HAS to get out about this! If she knew that in 2018, who knows, maybe the second palsy might never have happened had I gotten diagnosed and treated the first time!
Thanks for sharing.