Can Lyme Disease Cause Vision Loss, Blurred Vision, or Optic Neuritis?
A woman developed progressive vision loss over three weeks.
Her optic neuritis was ultimately linked to Lyme disease.
Ocular Lyme disease can affect vision, color perception, and the optic nerve.
Welcome to an Inside Lyme case study. I find that one of the best ways to understand Lyme disease is by reviewing actual patient cases. In this episode, I discuss a 46-year-old woman whose worsening vision problems led clinicians to diagnose Lyme disease-associated optic neuritis.
Jha and colleagues first reported this case in the Wisconsin Medical Journal in 2018.
A 46-year-old woman developed blurred vision that progressively worsened over three weeks.
She also reported tingling and numbness in both legs, nausea, weakness, dizziness, and visual hallucinations.
Her medical history included hypertension, asthma, post-traumatic stress disorder, depression, seizure disorder, and alcohol use disorder. She also reported having Lyme disease 10 years earlier that had been treated for 10 days.
An optometrist had evaluated her 13 days before hospitalization and found optic disc edema. She was advised to seek emergency care but initially declined.
When she was finally examined by ophthalmology, clinicians confirmed optic neuritis, an inflammatory condition affecting the optic nerve.
Her vision loss was severe. Visual acuity measured 20/400 in both eyes, meeting criteria for legal blindness. She also demonstrated impaired color vision in both eyes.
Lyme Disease and Optic Neuritis
Blood testing supported a diagnosis of Lyme disease. Her Lyme IgM antibodies and Western blot IgM were positive. Her IgG Western blot showed three reactive bands but did not meet CDC surveillance criteria for a positive IgG immunoblot.
Clinicians could not identify another explanation for her optic neuritis.
The authors concluded that the case fulfilled criteria for acute Lyme disease and that the optic neuritis was likely related to a recent infection rather than her Lyme disease episode from a decade earlier.
The patient was treated with doxycycline. After beginning antibiotics, she reported some improvement in her vision.
Unfortunately, the final outcome remained uncertain because she later left the hospital against medical advice and did not return for follow-up care.
Can Lyme Disease Affect the Eyes?
Yes. Although ocular manifestations are considered less common than joint or neurologic symptoms, Lyme disease has been associated with a broad range of eye disorders.
A review by Lesser described conjunctivitis, keratitis, neuroretinitis, optic neuritis, optic atrophy, disc edema, and cranial nerve involvement among the reported ocular manifestations of Lyme disease.
More recently, a 2026 systematic review and meta-analysis involving 859 patients found that ocular findings may be more common than previously appreciated. Reported manifestations included conjunctivitis, keratitis, diplopia, cranial nerve palsies, retinal inflammation, neuroretinitis, and optic nerve abnormalities.
These findings reinforce the importance of considering Lyme disease when patients develop unexplained visual symptoms, particularly in endemic regions.
Can Lyme Disease Cause Color Vision Loss?
Color vision abnormalities can occur when Lyme disease affects the optic nerve.
In this case, the patient experienced impaired color vision in both eyes along with severe visual loss. Patients with optic neuritis often describe colors appearing faded, dull, or less vivid than normal.
Because changes in color vision may occur before complete vision loss develops, clinicians evaluating unexplained optic neuritis should consider Lyme disease among the possible causes.
Why Lyme Disease Is Often Missed in Patients With Vision Problems?
Ocular manifestations of Lyme disease are frequently overlooked because patients may present primarily to eye specialists rather than physicians familiar with tick-borne illness.
According to a recent review on ocular Lyme disease, approximately half of patients do not recall a tick bite and many never develop a recognized erythema migrans rash.
As a result, Lyme disease may not initially be considered when patients present with optic neuritis, blurred vision, double vision, or other unexplained ocular findings.
What Can We Learn From This Case?
- Lyme disease should be included in the differential diagnosis of optic neuritis.
- Vision loss and color vision abnormalities may occur in Lyme disease.
- Patients presenting with unexplained ocular symptoms may benefit from evaluation for tick-borne illness when clinically appropriate.
- A history of Lyme disease years earlier does not exclude a new infection.
Frequently Asked Questions
Can Lyme disease cause blurred vision?
Yes. Lyme disease has been associated with blurred vision, optic neuritis, cranial nerve palsies, and other ocular manifestations.
Can Lyme disease cause optic neuritis?
Yes. Several case reports and reviews have described optic neuritis as a neurologic and ocular manifestation of Lyme disease.
Can Lyme disease affect color vision?
Yes. Optic neuritis can impair color perception, causing colors to appear faded or less vivid.
Can Lyme disease cause blindness?
Severe visual impairment has been reported in Lyme disease-associated optic neuritis, although ocular manifestations are considered uncommon.
Clinical Takeaway
Lyme disease can affect the eyes in several ways, including blurred vision, optic neuritis, reduced color vision, cranial nerve palsies, and retinal inflammation. In this case, a 46-year-old woman developed bilateral optic neuritis with severe vision loss and impaired color vision. Recent reviews suggest ocular manifestations may be more common than previously recognized. Clinicians evaluating unexplained optic neuritis, visual loss, or color vision abnormalities should consider Lyme disease in the differential diagnosis, particularly in endemic areas.
Related Articles
Ocular Lyme Disease: Eye Symptoms and Vision Problems
Neurologic Lyme Disease: Signs and Symptoms
Brain Fog in Lyme Disease
Lyme Disease Symptoms Guide
Can Lyme Disease Cause Ocular Migraines?
References
- 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.
- Lesser RL. Ocular manifestations of Lyme disease. Am J Med. 1995;98(4A):60S-62S.
- Barbosa LIT, Lima RV, Moreira JLM, et al. Ocular findings in patients with Lyme disease: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2026;264(4):1101-1110.
- Thomsen ML, Raposo FM, Greenberg PB, Janigian RH, Gaitanis MM, Hunter AM. Diagnostic Testing for Patients With Suspected Ocular Manifestations of Lyme Disease. Fed Pract. 2025;42(1):58-61.
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
