Lyme disease causes vision loss in 46-year-old woman
There have been several case reports linking Lyme disease with eye problems, including a loss of vision. In a study by the Mayo Clinic, researchers concluded that "although ocular involvement can be self-limited, delays in diagnosis may result in vision impairment and even blindness." 
A recent article published in the Wisconsin Medical Journal describes the case of a 46-year-old woman who experienced a sudden onset of bilateral vision loss and paresthesias.
According to Jha and colleagues from the Medical College of Wisconsin, the woman developed blurred vision, which progressively worsened over a 3-week period.  This reportedly began after she had upper respiratory tract symptoms. In addition, the woman had nausea, weakness, dizziness, and tingling/numbness in her lower extremities.
“After extensive workup, she was diagnosed with Lyme optic neuritis based on the clinical presentation and positive serology,” writes Jha.
Optic neuritis is inflammation of the optic nerve. The condition typically causes temporary vision loss in one eye and is often associated with multiple sclerosis (MS).
In this case, the vision loss was significant. Using the Snellen Eye Test Charts her visual acuity was 20/400 in both eyes. Color vision was impaired in both eyes, as well. “A dilated fundus exam demonstrated bilateral optic head edema, hyperemia, and optic nerve elevation concerning for intracranial hypertension,” according to Jha.
Other conditions were ruled out. “The inpatient workup ruled out posterior reversible encephalopathy syndrome, idiopathic intracranial hypertension, multiple sclerosis, meningitis (viral, fungal, tuberculosis, syphilis, and other bacterial), autoimmune process and cerebrovascular disease,” Jha states.
Eye problems in tick-borne diseases other than Lyme
The woman fulfilled the criteria for acute Lyme infection with a positive 2-tiered serology test (positive immunoassay). “Our case also fulfilled the criteria for acute Lyme disease with strong evidence of a causal link with optic neuritis, as described by Sibony,” writes Jha.Lyme and other tick-borne diseases can cause eye problems, including vision loss and blurred vision. Click To Tweet
The woman was prescribed 2 weeks of doxycycline but after one week was admitted to the hospital for alcohol intoxication. “Upon questioning, she endorsed some improvement in vision after initiation of antibiotic,” writes Jha.
But the final outcome is uncertain, since the woman left the hospital against medical advice and did not adhere to her follow-up appointments. “Whether her symptoms resolved completely thereafter is unknown,” Jha states.
Growing list of eye problems in Lyme disease
The authors stress the need to include Lyme disease in differential diagnosis of optic neuritis. “More reporting of the cases is essential to draw enough attention from the clinicians and researchers to help devise evidence-based guidelines on the approach to diagnose and manage this condition.”
- 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.
- Jha P, Rodrigues Pereira SG, Thakur A, Jhaj G, Bhandari S. A Case of Optic Neuritis Secondary to Lyme Disease. Wmj. 2018;117(2):83-87.
Many years living in the eastern US where ticks are prolific, I have had multiple bites over the years. There was one specific bite at the base of the hairline around 2005 that still to this day gets a raised painful spot every few months as if there is a connection with that tick bite. I also started getting quite unwell around that time and begannto have vision issues. To make a long story short, I’ve searched for many years for answers. Being tested for Lyme, lupus autoimmune…. And finally 2 years ago an eye specialist after visiting many over the years, diagnosed atopic kerato conjunctivitis. One eye has lost vision. All I see is white and they said it is scar tissue. I’ve been rushed to ER more than once during episodes. There is a strong feeling this is actually Lyme associated, but after so many years have had too much damage.
I often see patients who have chronic irritation at the site of a tick bite without Lyme disease. I advise my patients to look a second time at Lyme disease even if the tests are negative. There are often other problems that help with the diagnosis.
After noticing a small mark on my neck last May 2020 I have suffered from well over 80 symptoms with every area of my body affected no diagnosis, infection in stomach only positive test not been believed now my eyes are been affected I worry for my future
I advise my patients with multiple unexplained symptoms to include an evaluation with a doctor experienced in using clinical judgement instead of a test in addition to a neurologist and an ophthalmologist.
I was diagnosed with a spider bite around 2004- got progressively worse over the years and finally diagnosed with Lyme and coinfections in 2008. It’s been a battle since. I’ve had 3 episodes of optic neuritis – in the middle of one right now. I’ve had two PICC lines in the past. While long term antibiotics have helped each time, I’ve also permanently lost some vision each time. I’m terrified that soon I will just be completely blind with no options. My color vision in both eyes is horrendous and I’ve noticed a major change in depth perception. I’ve seen some of the best optic neurologists out there and nobody has answers. Praying we all find answers to this.
Praying for you Rachel 🙏 the Lord hears your prayers and sees your tears 🙏
I was diagnosed with neurological lyme disease in the spring of 2016 after being misdiagnosed for 11 years. I was originally diagnosed with a spider bite at an urgent care facility in the Spring of 2005. I live approximately an hour Southeast of Knoxville, Tennessee. I have had blurred vision for many years. I have had 5 PICC lines with many months of IV antibiotics in the past 5 years. This past Saturday I fell and hit my head. I had sudden vision loss in my left eye. CT at the ER ruled out a concussion. ER physician referred me to a local optometrist who diagnosed me with a server case of optic neuritis. I told him I have neurological lyme disease, but he was adamant that I most likely have MS. I am scheduled with a retinal specialist at 10 a.m. this morning from the University of Tennessee at Knoxville. His name is Dr. Barb and I hope he listens to me when I tell him that I have neurological lyme and thinks outside the box. I am terrified my vision will not return in my left eye. There is so much diminished color and my central vision is all grey. My cognitive function has diminished since the fall and my short term memory is almost non existent. I am so glad I found this article and will show it to Dr Barb and insist that the optic neuritis is caused by lyme. I was misdiagnosed for too many years to sit quietly and accept the standard diagnosis and protocol.
I was diagnosed in 2015 and still have bells palsy, bad anxiety, and terrible vision. I started getting many cysts on my skull. I’ve also, after diagnosis, become very angry and impatient with absolutely no filter. Heart palpitations which went on for years. I’ll be 34 this week and my face will be like this forever. I was told I have 5th and 7th cranial nerve damage. My short term memory is non existent and I hate it.
I’m curious why BRAO wasn’t mentioned as an eye problem with Lyme and coinfections. I was diagnosed 4 years post onset of symptoms, 1 year into treatment I had sudden onset of left eye blindness. Head CT done, vascular work up with sonography, all negative. LLMD told me cause was biofilm.
BRAO has been reported in Lyme disease in the the published literature. There are often findings that have been published but do not make it on a list. Your comments remind us all to include Lyme disease in a growing number of eye findings.
“The central retinal artery, a branch of the ophthalmic artery, enters the eye through the optic disc and divides into multiple branches to perfuse the inner layers of the retina. A branch retinal artery occlusion (BRAO) occurs when one of these branches of the arterial supply to the retina becomes occluded.” according to emedicine.