Lyme Disease Eye Problems – Part Two

by lmatthews on August 3, 2012



Lyme Disease, MS, and Visual Field Defects

Eye problems from Lyme disease may appear mild and intermittent at first, such as a stinging in the eye, blurred vision, or even floaters or partial loss of the field of vision. An early sign of Multiple Sclerosis, particularly in younger women is partial vision-loss or other apparent neurological abnormality creating visual symptoms. Added to other overlapping symptoms between Lyme disease and MS it is easy to see why misdiagnosis so frequently occurs. WIth MS being an immune system disorder the treatment frequently involves suppression of the immune system with corticosteroids which, if the real cause of the visual symptoms is Lyme disease, would make the infection worse.

Natural Lyme Disease Therapies

Patients dealing with persistent symptoms of Lyme disease in their eyes may find it helpful to use natural anti-inflammatory treatment alongside their prescription medications (with their physicians’ approval, of course). Quercetin, bromelain, and even antioxidant vitamins E and C may be helpful to strengthen the immune system, lower systemic inflammation, and go some way to reducing free radical damage to the eyes. Patients should be wary of driving when suffering from ocular symptoms of Lyme disease as this may be both unsafe and illegal.

Testing for Lyme Diseaase

Whenever vision problems arise it is important to consult an ophthalmologist who may then refer cases on to a neuro-ophthalmologist or to a general practitioner if deemed necessary. Asensio Sánchez, et al (2003), reported a case of a patient whose only early symptom of Lyme disease was diplopia (double vision), with the infection confirmed by ELISA and treatment with antibiotics successful in resolving the infection and symptoms. Other researchers have noted isolated uveitis in both adults and children with Lyme disease and it may be expected that there are many patients whose symptoms continue while the long list of differential diagnoses are considered.


Vision Problems in Children with Lyme Disease

Systemic symptoms are not always present alongside ocular manifestations of Lyme disease but researchers in France did observe a variety of such symptoms in cases reported in a Strasbourg hospital between 2000 and 2010. Six children were treated for Lyme disease during this period and their symptoms included Lyme arthritis, rash, and erythema migrans in all cases, along with severe knee arthritis in two patients. The eye problems related to Lyme disease varied with two children suffering from uveitis, two from abducens palsies, one with optical neuropathy, and one with orbital myositis. Sauer, et al (2012), noted that any unexplained ocular symptoms, even in children, should prompt serological testing for Lyme borreliosis, especially in endemic areas. All of the patients were successfully treated with oral antibiotics and symptoms resolved within two to twelve weeks.

Permanent Eye Damage from Lyme Disease

Not all cases of ocular Lyme disease are so completely resolved, however. German researchers, Burkhard et al (2001), reported on the case of a fifty-eight year old woman who began experiencing symptoms within six weeks of a tick bite. The infection led to permanent visual field defects due to ischaemic lesions of the optic disc despite eventual antibiotic treatment that resolved the Lyme borreliosis. A letter to the British Medical Journal, published this month, noted that a self-limited follicular conjunctivitis is the most common visual symptom of Lyme disease, occurring in around 10% of cases. The letter also stated that some 4.3% of all cases of uveitis can be blamed on Lyme disease and that physicians should be suspicious of the involvement of Lyme borreliosis in cases where patients present with eye pain, redness, photophobia, or reduced visual acuity.

lyme disease eye problems

Consulting an ophthalmologist could reveal Lyme disease as the cause of blurred vision, double vision, or loss of visual acuity.


Improving Awareness of Lyme Disease Eye Problems

Even as early as 1991, a researcher in Florida published a paper calling for physicians to ask questions about patients’ exposure to tick endemic areas, recent skin rashes, and other Lyme disease symptoms when presenting with chronic iritis with posterior synechiae, vitritis in one or both eyes, an atypical pars planitis-like syndrome, big blind spot syndrome, and swollen or hyperemic optic discs. Smith, the paper’s author, discussed proper action to obtain a Lyme disease diagnosis and the need for further research into the ocular manifestations of Lyme disease at this time.

Many physicians remain unaware of the potential for Lyme disease infection to cause vision problems, especially in states where borreliosis is still considered rare or non-existent. Patients must, therefore, educate themselves on the potential ocular symptoms of Lyme disease so that blurred vision, double vision, swollen eyes, visual field loss, and other eye problems are not left to worsen without treatment.

References


Kadz B, Putteman A, Verougstraete C, Caspers L., Lyme disease from an ophthalmological point of view, J Fr Ophtalmol. 2005 Feb;28(2):218-23.

Asensio Sánchez VM, Corral Azor A, Bartolomé Aragón A, De Paz García M., Diplopia as the first manifestation of Lyme disease, Arch Soc Esp Oftalmol. 2003 Jan;78(1):51-4.

Mattéi J, Pélissier P, Richard O, Manoli P, Girod JP, Cazorla C, Bru JP, Stéphan JL., Lyme uveitis: 2 case reports, Arch Pediatr. 2011 Jan;18(1):49-53. Epub 2010 Dec 8.

Int J Med Sci. 2009; 6(3): 124–125.
Published online 2009 March 19.

Sauer A, Hansmann Y, Jaulhac B, Bourcier T, Speeg-Schatz C., Ocular Lyme disease occurring during childhood: five case reports, J Fr Ophtalmol. 2012 Jan;35(1):17-22. Epub 2011 Jun 22.

Burkhard C, Gleichmann M, Wilhelm H., Optic nerve lesion following neuroborreliosis: a case report. Eur J Ophthalmol. 2001 Apr-Jun;11(2):203-6.

Duncan CJA, Carle G, Seaton A. Tick bite and early Lyme Borreliosis. BMJ 2012;344:e3124

Weinberg RS. Ocular Involvement in Lyme disease. Current Insight – American Academy of Ophthalmology 2008

Mikkila HO, Ilkka JT, Seppala I, Viljanen MK, Peltomaa MP, Karma A. The Expanding Clinical Spectrum of Ocular Lyme Borreliosis
Ophthalmology 2000;107:581–587

Mikkila H, Seppala I, Leirisalo-Repo M, Immonen I, Karma A. The etiology of uveitis: the role of infections with special reference to Lyme borreliosis. Acta Ophthalmologica Scandinavica, 12 1997, vol./is. 75/6(716-9).

Smith JL., Neuro-ocular Lyme borreliosis. Neurol Clin. 1991 Feb;9(1):35-53.


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