Lyme Disease and Vision Loss: When It Mimics Giant Cell Arteritis

Lyme disease can cause vision problems, including rare cases of sudden vision loss—sometimes mimicking other serious conditions such as giant cell arteritis (GCA).

This is where overlapping diagnoses can delay recognition.

This is where one diagnosis can overshadow another.

In a case report by Wan and colleagues, an elderly woman presented with acute vision loss and was found to have both giant cell arteritis and Lyme neuroborreliosis.

Start here: Lyme disease symptoms guide

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Can Lyme Disease Cause Vision Loss?

What causes sudden vision problems?

Acute vision loss can have several causes—some more urgent than others.

Giant cell arteritis is a form of vasculitis that affects arteries near the temples and can lead to:

• Headaches
• Jaw claudication (pain while chewing)
• Visual disturbances or vision loss

Meanwhile, Lyme disease is one of several infections that can affect the eyes.

Although uncommon, Lyme disease has been associated with optic neuritis, an inflammation of the optic nerve that can cause pain and blurred vision.

Both Lyme disease and giant cell arteritis are recognized causes of vision loss.

This is where symptoms can overlap—and create diagnostic uncertainty.

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What Happened in This Case?

How did these conditions present together?

An 80-year-old woman was admitted with:

• Abrupt blurry vision in the left eye
• Right-sided weakness
• Dysarthria
• Jaw pain and headache
• Left facial droop

A temporal artery biopsy confirmed giant cell arteritis, and she was treated with high-dose corticosteroids.

This is where partial improvement created uncertainty.

Her vision improved somewhat—but not completely.

Because she lived in a Lyme-endemic region, clinicians ordered Lyme testing.

The results were positive, with five IgG bands on Western blot, consistent with Lyme neuroborreliosis.

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How Was Lyme Disease Treated?

What happens when infection is also present?

The patient was treated with intravenous ceftriaxone, followed by oral doxycycline.

This is where dual pathology complicates treatment decisions.

At discharge, her vision remained reduced but was improving and stable.

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Was Lyme Disease the Cause of Vision Loss?

This is where the diagnosis becomes less clear.

The authors noted that the improvement with corticosteroids suggested that giant cell arteritis was likely the primary cause.

However, they emphasized that Lyme disease could not be completely ruled out as a contributing factor.

This highlights a key clinical challenge—more than one condition may be present at the same time.

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Why This Case Matters

What should clinicians consider?

This case highlights how Lyme disease can overlap with other causes of vision loss.

In Lyme-endemic areas, physicians should include Lyme disease in the differential diagnosis when evaluating patients with acute vision loss.

This is where important diagnoses can be missed or overshadowed.

Conditions such as GCA may explain the presentation—but coexisting infections may still be present.

See related discussion in Lyme disease and eye problems.

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Clinical Takeaway

Lyme disease can contribute to vision problems—even when another diagnosis appears more likely.

In complex cases, more than one condition may be involved.

If vision loss doesn’t fully fit the expected diagnosis, it’s worth asking why—again.

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Related Reading

• Lyme disease and double vision
• Lyme disease causes vision loss in adults
• Lyme disease associated with eye problems

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References

1. Wan, L., Yan, A., Reese, E., et al. (2024). Through the eyes of uncertainty: Giant cell arteritis and Lyme neuroborreliosis in a story of vision loss. Cureus, 16(2), e53623. https://doi.org/10.7759/cureus.53623

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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