Can Lyme Disease Cause Double Vision?

Yes—Lyme disease can cause double vision, although it is a less common neurological symptom.

In some cases, double vision may be one of the first neurological signs of Lyme disease.

Double vision in Lyme disease is most often caused by cranial nerve palsy affecting eye movement.

Double vision (diplopia) occurs when the eyes are not properly aligned, causing a person to see two images instead of one.

For a broader overview, see Lyme disease symptoms guide.

How Lyme Disease Can Cause Double Vision (Cranial Nerve Palsy)

Lyme disease can affect the cranial nerves responsible for eye movement, including the third cranial nerve.

• Inflammation of cranial nerves
• Lyme meningitis affecting the brain and nerves
• Disruption of eye muscle coordination

Although facial nerve palsy (Bell’s palsy) is more common, other cranial nerves may also be involved.

Case: Lyme Disease and Double Vision From Cranial Nerve Palsy

This case illustrates how Lyme disease can present with double vision due to cranial nerve involvement.

This is a less common presentation compared to facial nerve palsy (Bell’s palsy), which affects the seventh cranial nerve.

Dixit and colleagues described a 69-year-old man who presented to an emergency room with headaches and diplopia.

The patient had been hiking in a rural area of New York but did not recall a tick bite or rash.

His headache began in the right occipital region and progressed toward the orbit. Within five days, he developed double vision.

He reported that covering one eye resolved the double vision, consistent with cranial nerve dysfunction.

On examination, he was found to have a third cranial nerve palsy affecting eye movement and pupil function.

Laboratory testing confirmed Lyme disease, including positive blood tests and elevated spinal fluid titers.

He was diagnosed with Lyme meningitis affecting the oculomotor nerve and treated with intravenous antibiotics.

His double vision resolved following treatment.

Why Double Vision Can Be Missed in Lyme Disease

• Symptoms may occur without a known tick bite or rash
• Double vision has many possible causes (stroke, tumor, diabetes)
• Less common cranial nerve involvement may not be immediately recognized

Because double vision has many possible causes, Lyme disease may not be considered initially.

For more on diagnostic challenges, see why Lyme tests can be negative.

FAQ: Lyme Disease and Double Vision

Can Lyme disease cause double vision?
Yes. Lyme disease can affect cranial nerves that control eye movement, leading to double vision.

Is double vision common in Lyme disease?
No. It is less common than facial paralysis but is a recognized neurological complication.

What causes double vision in Lyme disease?
Inflammation of cranial nerves or Lyme meningitis can disrupt eye movement and alignment.

Can Lyme disease cause vision loss?
In rare cases, Lyme disease can affect the eyes or optic nerve, but most visual symptoms improve with treatment.

Can double vision from Lyme disease be treated?
Yes. With appropriate antibiotic treatment, symptoms often improve or resolve.

Clinical Takeaway

Lyme disease can affect multiple cranial nerves, not just the facial nerve, and may present with double vision.

Recognizing neurological symptoms such as diplopia is important for early diagnosis and treatment.

In many cases, symptoms improve with appropriate therapy.

---

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