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.

[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



  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.

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

  • Karen Rowehl
    05/22/2023 (4:33 pm)

    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!

  • Kathy Adams
    06/10/2021 (10:37 am)

    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.

    • Dr. Daniel Cameron
      06/10/2021 (2:55 pm)

      I pray that you get the right diagnosis. I find patients with a tick borne infection other symptoms that help in the diagnosis.

    02/26/2021 (3:24 pm)

    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?

    • Dr. Daniel Cameron
      02/27/2021 (7:35 am)

      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.

  • Michael Harwell Jr
    12/07/2020 (8:57 am)

    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?

    • Dr. Daniel Cameron
      12/07/2020 (11:26 am)

      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.

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