Lyme disease causes double vision: case report

The Lyme spirochete Borrelia burgdorferi can invade the central nervous system causing neuroborreliosis. The most common symptoms include headaches, neck stiffness, facial palsy, and peripheral neuropathy. But the disease can, on rare occasions, also cause eye-related problems. “We present a case of neuroborreliosis manifesting with diplopia [double vision],” Dixit and colleagues write. [1]

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.

Case report describes a man who developed headaches and double vision caused by Lyme disease.

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.

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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



  1. Dixit A, Garcia Y, Tesoriero L, Berman C, Rizzo V. Diplopia: A Rare Manifestation of Neuroborreliosis. Case Rep Neurol Med. 2018;2018:9720843.
  2. 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.

13 Replies to "Lyme disease causes double vision: case report"

  • Brendi
    03/05/2020 (9:53 am)

    Do the nervous and vision symptoms disappear after successful treatment of the disease? Does the patient in this article have any symptoms?

    • Dr. Daniel Cameron
      03/05/2020 (11:46 am)

      “His diplopia resolved and he was asymptomatic two months after initiation of therapy.” wrote the authors. I have patients who remain ill after treatment.

  • Jan
    11/01/2018 (10:01 pm)

    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.

    • Dr. Daniel Cameron
      11/05/2018 (9:18 am)

      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.

  • Donny Wilmer
    09/06/2018 (3:47 am)

    What are the parallels between
    neuroborreliosis and neurosyphilis?
    Both are caused by spirochetes.

    • Dr. Daniel Cameron
      09/07/2018 (7:24 pm)

      There are many parallels.

    • Dr. Daniel Cameron
      09/07/2018 (7:27 pm)


  • Terrye Edye
    09/05/2018 (11:09 pm)

    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

    • Dr. Daniel Cameron
      09/07/2018 (7:23 pm)

      Your doctor may have to use clinical judgment if the tests are negative for tick borne illness.

    • Dr. Daniel Cameron
      09/07/2018 (7:28 pm)

      Your doctor will have to use clinical judgment

  • john topper
    09/05/2018 (4:14 am)

    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 ?

    • Dr. Daniel Cameron
      09/07/2018 (7:22 pm)

      The vision loss could have been an optical migraine. Your ophthalmologist would have to rule out a retinal tear. I am not an ophthalmologist but remain interested in the subject. I assume you have a broad range of problems. You might benefit from adding a doctor familiar with Lyme disease.

    • Dr. Daniel Cameron
      09/07/2018 (7:31 pm)

      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.

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