Can Lyme Disease Cause Vision Loss? A Case of Lyme Disease and Giant Cell Arteritis

Sudden vision loss and Lyme disease
When giant cell arteritis can mimic neuroborreliosis
Why the correct diagnosis matters

Can Lyme disease cause vision loss? Although uncommon, Lyme disease has been associated with optic neuritis and other ocular complications that may affect vision. A 2024 case report describes an 80-year-old woman with sudden blurry vision, neurologic symptoms, a positive Lyme disease test, and biopsy-confirmed giant cell arteritis.¹

This case highlights the challenge of distinguishing Lyme neuroborreliosis from other conditions that can threaten vision. Patients with suspected Lyme disease may also require evaluation for vascular, inflammatory, and neurologic disorders. Learn more in our Lyme disease symptoms guide.

In this patient, the temporal artery biopsy strongly supported giant cell arteritis. However, because cerebrospinal fluid was never examined, physicians could not completely exclude concurrent Lyme neuroborreliosis.

What Can Cause Sudden Vision Loss?

Sudden vision loss is a medical emergency with many possible causes, including retinal vascular occlusion, retinal detachment, optic neuritis, stroke, autoimmune disease, infection, and giant cell arteritis.

Giant cell arteritis is an inflammatory disease affecting medium- and large-sized arteries, particularly in adults over 50 years of age. When the arteries supplying the optic nerve become inflamed, permanent vision loss may occur unless treatment is started promptly.

Common symptoms include:

• New or severe headache
• Temporal artery or scalp tenderness
• Jaw pain while chewing
• Blurred or double vision
• Sudden partial or complete vision loss
• Shoulder or hip stiffness
• Fatigue, fever, or weight loss

Because irreversible visual injury can occur within hours or days, physicians often begin corticosteroid treatment before biopsy results are available when giant cell arteritis is strongly suspected.

Can Lyme Disease Affect Vision and the Eyes?

Although uncommon, Lyme disease may affect the eyes directly or through involvement of the nervous system. Most reported ocular complications occur during disseminated Lyme disease or Lyme neuroborreliosis.

Reported manifestations include:

• Conjunctivitis
• Keratitis
• Uveitis
• Optic neuritis
• Optic disc swelling
• Retinal vascular inflammation or occlusion
• Cranial nerve palsies causing double vision
• Facial nerve palsy

Optic neuritis may lead to blurred vision, eye pain, impaired color vision, or vision loss. A systematic review concluded that Lyme-associated optic neuritis is rare and that diagnosis requires more than a positive Lyme antibody test.²

Because these eye complications are uncommon and nonspecific, clinicians must consider the patient’s entire clinical presentation rather than relying on laboratory results alone.

A Patient Develops Sudden Blurry Vision

Wan and colleagues described an 80-year-old woman from Pennsylvania who presented with sudden blurry vision in her left eye.¹

Additional symptoms included:

• Left jaw pain
• Headache
• Temporal artery tenderness
• Transient left facial weakness
• Right-sided weakness
• Slurred speech

Visual acuity measured 20/25 in the right eye and 20/200 in the left eye. The combination of visual loss and transient neurologic deficits initially raised concern for a stroke or transient ischemic attack.

Did the Patient Have a Stroke?

MRI of the brain and orbits, CT angiography of the head and neck, carotid ultrasound, and echocardiography did not identify an acute stroke, hemorrhage, arterial dissection, or major vascular obstruction.

Her facial weakness, right-sided weakness, and slurred speech resolved. Nevertheless, clinicians considered the episode consistent with a possible transient ischemic attack and initiated short-term antiplatelet therapy.

Because the patient’s visual symptoms persisted alongside jaw pain, headache, and temporal artery tenderness, physicians increasingly suspected giant cell arteritis.

Why Was Giant Cell Arteritis Suspected?

Several clinical features strongly supported giant cell arteritis:

• Age over 50 years
• Sudden unilateral vision loss
• New headache
• Temporal artery tenderness
• Jaw claudication
• Optic disc swelling

Optical coherence tomography demonstrated optic disc edema. Rheumatology and ophthalmology consultants recommended a temporal artery biopsy.

The biopsy showed inflammatory cell infiltration, thickening of the arterial wall, and multinucleated giant cells, confirming giant cell arteritis.

High-dose corticosteroid therapy was started promptly. Her vision improved gradually but did not completely return to normal.

Why Was the Patient Tested for Lyme Disease?

Before starting tocilizumab, physicians evaluated the patient for active infections. Because she lived in a Lyme-endemic region, Lyme disease serologic testing was obtained and demonstrated a positive Lyme IgG immunoblot.

The positive result raised the possibility that Lyme neuroborreliosis could have contributed to her neurologic findings. However, a positive IgG test alone cannot distinguish active neurologic infection from previous exposure.

Did the Patient Have Lyme Neuroborreliosis?

The diagnosis remained uncertain. The patient declined a lumbar puncture, preventing cerebrospinal fluid (CSF) analysis that might have confirmed or excluded Lyme neuroborreliosis.

When neurologic Lyme disease is suspected, CSF studies can help determine whether the nervous system is actively involved. Depending on the clinical presentation, physicians may evaluate for inflammation and compare Lyme antibody production in the CSF and blood.

Because no CSF testing was performed, the positive Lyme IgG blood test could not determine whether the patient had active Lyme neuroborreliosis or evidence of a previous Lyme infection.

The authors concluded that giant cell arteritis remained the most likely explanation for the patient’s vision loss because of the positive temporal artery biopsy and improvement after corticosteroid therapy.¹

How Was the Patient Treated?

The patient was treated for both biopsy-confirmed giant cell arteritis and possible Lyme neuroborreliosis.

For giant cell arteritis, she received high-dose corticosteroids followed by a taper. Her visual acuity improved from 20/200 to 20/100 before discharge.

Because Lyme neuroborreliosis could not be completely excluded, physicians also prescribed intravenous ceftriaxone (2 grams daily for 14 days), followed by oral doxycycline (100 mg twice daily for another 14 days).

Since both treatments were administered, the case cannot determine whether antibiotics contributed to the patient’s neurologic or visual improvement.

Was Lyme Disease Responsible for the Vision Loss?

This case does not establish that Lyme disease caused the patient’s vision loss.

Several findings strongly favored giant cell arteritis:

• Age greater than 50 years
• Jaw claudication
• New headache and temporal artery tenderness
• Positive temporal artery biopsy
• Clinical improvement after corticosteroid therapy

Evidence supporting active Lyme neuroborreliosis was more limited:

• Positive Lyme IgG immunoblot
• Residence in a Lyme-endemic region
• Transient facial weakness and neurologic symptoms
• No cerebrospinal fluid evaluation

The positive Lyme test remained clinically important but could not establish active neurologic Lyme disease or explain the patient’s visual loss by itself.

Why Giant Cell Arteritis and Lyme Disease Can Be Difficult to Distinguish

Although giant cell arteritis and Lyme neuroborreliosis are different diseases, they can occasionally present with overlapping neurologic and ocular findings.

Both conditions have been associated with:

• Headache
• Visual disturbances
• Double vision
• Facial weakness
• Optic nerve abnormalities
• Other neurologic symptoms

In Lyme-endemic regions, a positive Lyme antibody test may further complicate the evaluation. Physicians must interpret laboratory findings together with the patient’s history, examination, imaging studies, and, when appropriate, cerebrospinal fluid analysis.

Can Lyme Disease Mimic Giant Cell Arteritis?

Yes. Previous case reports have described Lyme neuroborreliosis initially being mistaken for giant cell arteritis because both disorders may present with headache, facial weakness, and visual symptoms.

In one report, three patients originally diagnosed with giant cell arteritis were ultimately found to have Lyme neuroborreliosis after cerebrospinal fluid testing demonstrated nervous system infection.³

An earlier case report also described temporal arteritis associated with Borrelia infection, although isolated reports do not establish that Lyme disease generally causes giant cell arteritis.⁴

Together, these reports remind clinicians to consider Lyme neuroborreliosis in selected patients with compatible neurologic findings, particularly in endemic regions.

Can Acute Vision Loss Be a Manifestation of Lyme Disease?

Acute vision loss has been reported in Lyme disease, but it remains an uncommon manifestation.

Published cases have described optic neuritis, optic disc swelling, retinal vascular inflammation, cranial nerve palsies causing double vision, keratitis, and uveitis.²

Because these findings occur in many inflammatory, infectious, vascular, and autoimmune disorders, Lyme disease should remain part of the differential diagnosis rather than be assumed to be the primary cause.

Frequently Asked Questions

Can Lyme disease cause blurry vision?

Yes. Lyme disease has been associated with uncommon ocular complications such as optic neuritis, keratitis, uveitis, retinal vascular inflammation, and cranial nerve palsies that may cause blurred or double vision. However, these findings require careful evaluation because many other conditions can produce similar symptoms.

Can Lyme disease cause sudden vision loss?

Rarely. Sudden vision loss has been reported in patients with Lyme neuroborreliosis, particularly when optic neuritis or retinal vascular involvement is present. Because giant cell arteritis, retinal artery occlusion, retinal detachment, and stroke are more common causes, immediate medical evaluation is essential.

What eye problems are associated with Lyme disease?

Reported ocular manifestations include conjunctivitis, keratitis, uveitis, optic neuritis, optic disc swelling, retinal vascular inflammation, and cranial nerve palsies causing double vision. These complications are uncommon and are not specific to Lyme disease.

Can Lyme disease mimic giant cell arteritis?

Yes. Lyme neuroborreliosis and giant cell arteritis can both present with headache, visual symptoms, facial weakness, and optic nerve abnormalities. A positive Lyme antibody test alone cannot distinguish between the two conditions.

Related Articles

Lyme Disease Symptoms  Guide
What Is Lyme Neuroborreliosis?
Why Lyme Disease Is Often Misdiagnosed

References:

1. Wan L, Yan A, Reese E, Thomas J, Kissinger M. Through the Eyes of Uncertainty: Giant Cell Arteritis and Lyme Neuroborreliosis in a Story of Vision Loss. Cureus. 2024;16(2):e53623.
2. Lu Y, Zand R. Characteristics of Lyme optic neuritis: a case report of Lyme-associated bilateral optic neuritis and systematic review of the literature. BMC Neurol. 2022;22(1):113.
3. Träisk F, Andersson M, Svenungsson E. Three cases of neuroborreliosis misdiagnosed as giant cell arteritis. Scand J Rheumatol. 2012;41(2):158-160.
4. Pizzarello LD, MacDonald AB, Semlear R, DiLeo F, Berger B. Temporal arteritis associated with Borrelia infection: a case report. J Clin Neuroophthalmol. 1989;9(1):3-6.
5. StatPearls Publishing. Lyme Disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing.

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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