Is Lyme Disease Affecting Your Sight? Ophthalmological Symptoms of Lyme Disease – Part One

by lmatthews on August 3, 2012

lyme disease eye problems tick in eyelashes

Tick among the eyelashes (courtesy of Dr. N. Massaro; Agrigento - Italy).

Short-term conjunctivitis and photophobia are just two of the potential ocular manifestations of early stage borreliosis, with other vision problems connected to Lyme disease including blurred vision, neuro-ophthalmologic symptoms, keratitis, uveitis, iritis, and retinal pigment epithelial detachment. These symptoms of Lyme disease affecting the eyes are thought to occur more frequently in children but can often be overlooked in patients of any age, particularly in the early stages where patients themselves may dismiss the symptoms as an isolated problem and not consult a doctor until more serious eye problems arise.

Dangers of Lyme Misdiagnosis

Lyme disease can affect any part of the eye, making it a differential diagnosis for unexplained vision problems in tick-infested areas. Where caught early and treated with antibiotics the prognosis is usually good but long-term infection that goes untreated has the potential to cause permanent damage to the eyes. Unfortunately, misdiagnosis of ophthalmological symptoms of Lyme disease can lead to the inappropriate use of steroids to reduce inflammation, creating a more favorable environment for the infection as the medication suppresses the immune system. Where corticosteroid treatment appears to be worsening an eye condition physicians may consider a bacterial cause of the condition and combine antibiotic treatment with anti-inflammatory medications for both palliative and curative action.

Early Lyme Disease Eye Problems

Early Lyme disease symptoms that can affect the eyes include conjunctivitis and photophobia. Photosensitivity can also occur with antibiotic use so patients being treated for early-stage infection might feel inclined to hide indoors away from light for a short period of time. These early symptoms are thought to be relatively short-lived, sometimes being replaced by more severe ocular manifestations of Lyme disease as the infection spreads and takes hold.

Neuro-Ophthalmological Lyme Disease Symptoms

Lyme neuroborreliosis as the spirochaetes enter the central nervous system and cause conditions such as cranial nerve VII (Bell) palsy, meningitis, and radiculopathy. Medical treatment is essential in such cases as permanent disability or even death are possible. Lyme disease sufferers may also experience blurred vision which can cause difficulties driving, as well as affecting work, study, and home-life. Papilloedema, optic atrophy, pseudomotor cerebri, or optic or retrobulbar neuritis can be symptoms of Lyme disease affecting the eyes and the symptoms can occur in both eyes or a single eye, sometimes even becoming transient between the two. Other neurological symptoms of Lyme disease may occur simultaneously, such as confusion, difficulty concentrating, memory deficits, and even depression or schizophrenia-like illness.

Severe Vision Problems in Lyme Disease

The possible symptoms of third-stage Lyme disease include a variety of inflammatory disorders of various structures of the eye such as the retina, iris, the vitreous (jelly) of the eye, surface of the eye, and the entire eye in some cases. Keratitis, vitreitis, and pars planitis are the most frequently observed symptoms of Lyme disease affecting the eye but episcleritis, symblepharon (the eyelid sticking to the cornea), iritis, uveitis, retinal vasculitis, chorioretinitis (inflammation of the thin, pigmented, vascular surface of the eye), orbital myositis (enlargement of the muscles around the eyes), and other inflammatory disorders can occur. There may also be accumulation of fluid in the eye as in cystoid macular oedema, as well as cranial nerve palsies and branch artery occlusion blocking circulation to the eyes.


Keratitis and Lyme Disease

Where keratitis occurs it is usually in both eyes and results in a patchwork of inflammation in the cornea at either a shallow or deep level, leading to clouding of the vision and the potential for long-term vision-loss if scarring occurs. Corticosteroid eye-drops can help but these would need to be combined with antibiotics if the cause of the eye condition is Lyme disease or other bacterial pathogen.

Diagnosing Lyme Disease Eye Problems

Diagnosing eye symptoms of Lyme disease means ruling out a lot of other potential diagnoses such as viral conjunctivitis, dilplopia, Herpes infections, Horner Syndrome, sarcoidosis, Rocky Mountain Spotted Fever and a variety of other conditions. MRI scans and contrast-enhanced CT scans may help in determining the origin of visual symptoms and the treatment most appropriate for the underlying cause. Early stage Lyme disease visual symptoms are generally considered to resolve themselves within a few days to a week and many patients remain undiagnosed and/or untreated for such symptoms.

Treating Visual Manifestations of Lyme Disease

Visual symptoms of Lyme disease at a later stage may also be self-limiting but supportive treatment can help prevent permanent damage arising and reduce suffering during this time. Topical corticosteroids are the usual treatment, as prednisolone acetate 1% of fluorometholone 0.1%. A two to three week course of intravenous ceftriaxone or penicillin is sometimes administered for patients with neuro-ophthalmic disease, pars planitis or vitreitis. Where symptoms are resolved the treatment is considered successful but some patients continue to experience recurrent bouts of Lyme uveitis even after the infection is eradicated; Corticosteroids are then used for such symptoms.

Read on for further discussion of diagnosis, treatment, case reports, and references for ocular manifestations of Lyme disease.

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