Eye / Occular Manifestations and Lyme
Eye / Occular Manifestations include: pain, visual impairment, photophobia, myodesospia, diplopia,
Conjuctivitis, keratitis, uveitis, ocular adnexa inflammation, neuro-ophthalmological alterations,
Rarer symptoms include: branch central retinal vein occlusion, blindness
See below for a selection of abstracts:
Acquired nystagmus in a 12-year-old boy as initial presentation of Lyme disease. J Fr Ophtalmol. 2011 May;34(5):325.e1-3. doi: 10.1016/j.jfo.2010.11.015. Epub 2011 Apr 14. [Article in French] Samimi S, Salah S, Bonicel P. Service d'ophtalmologie, centre hospitalier régional d'Orléans, 14, avenue de l'Hôpital, 45067 Orléans cedex 02, France. [email protected]
Abstract: We report the case of a 12-year-old boy presenting with acquired horizontal nystagmus, headaches, and vertigo. CT, MRI, viral tests, and the Lyme disease test were at first negative. We made the diagnosis of neuroborreliosis based on a repeated Lyme disease test and lumbar puncture revealing intrathecal synthesis of specific antibodies. Adjusted antibiotic treatment led to complete disappearance of symptoms. Lyme borreliosis is difficult to diagnose and should be sought in case of unusual neuro-ophthalmic signs, especially in children. PMID: 21496946 [PubMed - indexed for MEDLINE]
Abstract: We report the case of a 12-year-old boy presenting with acquired horizontal nystagmus, headaches, and vertigo. CT, MRI, viral tests, and the Lyme disease test were at first negative. We made the diagnosis of neuroborreliosis based on a repeated Lyme disease test and lumbar puncture revealing intrathecal synthesis of specific antibodies. Adjusted antibiotic treatment led to complete disappearance of symptoms. Lyme borreliosis is difficult to diagnose and should be sought in case of unusual neuro-ophthalmic signs, especially in children. PMID: 21496946 [PubMed - indexed for MEDLINE]
Bilateral retrobulbar optic neuritis as first signs of Lyme disease.
Med Arh. 2008;62(2):117-8.
Todorovic L, Ibisevic M, Alajbegovic A, Suljic-Mehmedika E, Jurisic V.
Source: Clinic for Neurology, Clinical center University of Sarajevo.
Abstract: Bilateral retrobulbar optic neuritis in young adults are most often caused by demyelinate disease (MS). In all cases where MS was eliminated, we have used selected tests regarding to history, clinical findings and differential diagnosis. Diagnosis of Lyme disease is approved by diagnostic criteria proposed by Center for Control and Prevention of disease. In our case diagnosis of Lyme disease was established by history of illness, clinical findings and positive serlological tests.
Med Arh. 2008;62(2):117-8.
Todorovic L, Ibisevic M, Alajbegovic A, Suljic-Mehmedika E, Jurisic V.
Source: Clinic for Neurology, Clinical center University of Sarajevo.
Abstract: Bilateral retrobulbar optic neuritis in young adults are most often caused by demyelinate disease (MS). In all cases where MS was eliminated, we have used selected tests regarding to history, clinical findings and differential diagnosis. Diagnosis of Lyme disease is approved by diagnostic criteria proposed by Center for Control and Prevention of disease. In our case diagnosis of Lyme disease was established by history of illness, clinical findings and positive serlological tests.
Cotton wool spots as possible indicators of retinal vascular pathology in ocular lyme borreliosis
Int Ophthalmol. 2010 Oct;30(5):599-602. doi: 10.1007/s10792-008-9268-5. Epub 2008 Oct 15.
Klaeger AJ, Herbort CP.
Source Augenaerzte Gurtengasse, 3011, Bern, Switzerland. [email protected]
Abstract: Lyme borreliosis is an underdiagnosed infectious disease caused by a spirochete and transmitted by certain Ixodes ticks. In Lyme disease diagnostic problems are still discussed extensively as the laboratory workup is not standardized and a positive antibody result is not proof of active infection. It is therefore important to appreciate all clinical signs that can prompt us to the diagnostic investigation of Lyme borreliosis. We present a case of a woman with Lyme borreliosis and recurrent unilateral anterior uveitis in her right eye for 2 years, who developed cotton wool spots (CWS) in her left eye, followed by acute and recurrent anterior uveitis in this second eye. An extensive general examination, including blood coagulopathies and ultrasound of the carotid arteries, did not reveal any pathology. The CWS resolved within a few months. The recurrent anterior uveitis could be controlled by topical steroids. After treatment with 2 g of i.v. ceftriaxone for 3 weeks, she remained free of recurrences for 1 year of observation time. CWS can be the first clinical sign of ocular vascular pathology and/or uveitis. Further investigation will be necessary to confirm the relationship between CWS and ocular borreliosis. In patients with otherwise unexplained CWS, the possibility of an infection with borreliosis should be ruled out carefully.
Int Ophthalmol. 2010 Oct;30(5):599-602. doi: 10.1007/s10792-008-9268-5. Epub 2008 Oct 15.
Klaeger AJ, Herbort CP.
Source Augenaerzte Gurtengasse, 3011, Bern, Switzerland. [email protected]
Abstract: Lyme borreliosis is an underdiagnosed infectious disease caused by a spirochete and transmitted by certain Ixodes ticks. In Lyme disease diagnostic problems are still discussed extensively as the laboratory workup is not standardized and a positive antibody result is not proof of active infection. It is therefore important to appreciate all clinical signs that can prompt us to the diagnostic investigation of Lyme borreliosis. We present a case of a woman with Lyme borreliosis and recurrent unilateral anterior uveitis in her right eye for 2 years, who developed cotton wool spots (CWS) in her left eye, followed by acute and recurrent anterior uveitis in this second eye. An extensive general examination, including blood coagulopathies and ultrasound of the carotid arteries, did not reveal any pathology. The CWS resolved within a few months. The recurrent anterior uveitis could be controlled by topical steroids. After treatment with 2 g of i.v. ceftriaxone for 3 weeks, she remained free of recurrences for 1 year of observation time. CWS can be the first clinical sign of ocular vascular pathology and/or uveitis. Further investigation will be necessary to confirm the relationship between CWS and ocular borreliosis. In patients with otherwise unexplained CWS, the possibility of an infection with borreliosis should be ruled out carefully.
Neuro-ophthalmologic manifestations of Lyme disease.
Ophthalmology. 1990 Jun;97(6):699-706. Neuro-ophthalmologic manifestations of Lyme disease.
Lesser RL, Kornmehl EW, Pachner AR, Kattah J, Hedges TR 3rd, Newman NM, Ecker PA, Glassman MI.
Source:Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT 06510.
Abstract: Lyme disease is a tick-borne spirochetal infection characterized by skin rash, neurologic, cardiac, and arthritic findings. The authors report six patients with Lyme disease who had neuro-ophthalmologic manifestations. One patient had meningitis with papilledema, two had optic neuritis, and one had neuroretinitis. Three patients had sixth nerve paresis, two of whom cleared quickly, whereas multiple cranial nerve palsies and subsequent optic neuropathy developed in another. Early recognition of neuro-ophthalmologic findings can help in the diagnosis and treatment of Lyme disease.
Ophthalmology. 1990 Jun;97(6):699-706. Neuro-ophthalmologic manifestations of Lyme disease.
Lesser RL, Kornmehl EW, Pachner AR, Kattah J, Hedges TR 3rd, Newman NM, Ecker PA, Glassman MI.
Source:Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT 06510.
Abstract: Lyme disease is a tick-borne spirochetal infection characterized by skin rash, neurologic, cardiac, and arthritic findings. The authors report six patients with Lyme disease who had neuro-ophthalmologic manifestations. One patient had meningitis with papilledema, two had optic neuritis, and one had neuroretinitis. Three patients had sixth nerve paresis, two of whom cleared quickly, whereas multiple cranial nerve palsies and subsequent optic neuropathy developed in another. Early recognition of neuro-ophthalmologic findings can help in the diagnosis and treatment of Lyme disease.
Ocular manifestations in children and adolescents with Lyme arthritis.
Br J Ophthalmol. 1999 Oct;83(10):1149-52.
Huppertz HI, Münchmeier D, Lieb W.
Source: Children's Hospital, University of Würzburg, Würzburg, Germany.
Abstract
BACKGROUND: Lyme arthritis is the most frequent late manifestation of Lyme borreliosis and has been associated with ocular inflammation.
METHODS: A group of 153 children and adolescents with arthritis, 84 of whom had Lyme arthritis and 69 other causes of arthritis, were followed prospectively for 22-73 (median 44) months in the course of a national study.
RESULTS: Three of 84 patients with Lyme arthritis had ocular inflammation (4%), including keratitis, anterior uveitis, and uveitis intermedia. All three had symptoms of decreased visual acuity. Whereas anterior uveitis disappeared without sequelae, a corneal scar and a permanent loss of visual acuity in the patients with keratitis and intermediate uveitis remained. Systematic examination of all patients revealed no further ocular involvement. Of 69 patients with other causes of arthritis who were followed in parallel as a control group, four of 15 patients with early onset pauciarticular juvenile rheumatoid arthritis had chronic anterior uveitis and two of 12 patients with juvenile spondyloarthropathy had acute anterior uveitis.
CONCLUSIONS: Ocular involvement with keratitis, anterior uveitis, and intermediate uveitis may occur in children and adolescents with Lyme arthritis. Visual loss appears to be symptomatic, making regular ocular screening of such patients unnecessary.
Br J Ophthalmol. 1999 Oct;83(10):1149-52.
Huppertz HI, Münchmeier D, Lieb W.
Source: Children's Hospital, University of Würzburg, Würzburg, Germany.
Abstract
BACKGROUND: Lyme arthritis is the most frequent late manifestation of Lyme borreliosis and has been associated with ocular inflammation.
METHODS: A group of 153 children and adolescents with arthritis, 84 of whom had Lyme arthritis and 69 other causes of arthritis, were followed prospectively for 22-73 (median 44) months in the course of a national study.
RESULTS: Three of 84 patients with Lyme arthritis had ocular inflammation (4%), including keratitis, anterior uveitis, and uveitis intermedia. All three had symptoms of decreased visual acuity. Whereas anterior uveitis disappeared without sequelae, a corneal scar and a permanent loss of visual acuity in the patients with keratitis and intermediate uveitis remained. Systematic examination of all patients revealed no further ocular involvement. Of 69 patients with other causes of arthritis who were followed in parallel as a control group, four of 15 patients with early onset pauciarticular juvenile rheumatoid arthritis had chronic anterior uveitis and two of 12 patients with juvenile spondyloarthropathy had acute anterior uveitis.
CONCLUSIONS: Ocular involvement with keratitis, anterior uveitis, and intermediate uveitis may occur in children and adolescents with Lyme arthritis. Visual loss appears to be symptomatic, making regular ocular screening of such patients unnecessary.
Ophthalmic manifestations in Lyme borreliosis
Przegl Epidemiol. 2002;56 Suppl 1:85-90. [Article in Polish]
Zagórski Z, Biziorek B, Haszcz D.
Source: Katedra i I Klinika Okulistyki Akademii Medycznej w Lublinie.
Abstract: We reviewed ophthalmic manifestations in Lyme borreliosis, concentrating on clinical and laboratory diagnosis, differential diagnosis and treatment options. Ocular involvement may occur in every stage of the disease. Conjunctivitis and episcleritis are the most frequent manifestations of the early stage. Neuro-ophthalmic disorders and uveitis occur in the second stage whereas keratitis, chronic intraocular inflammation and orbital myositis have been reported in the third stage of borreliosis.
Przegl Epidemiol. 2002;56 Suppl 1:85-90. [Article in Polish]
Zagórski Z, Biziorek B, Haszcz D.
Source: Katedra i I Klinika Okulistyki Akademii Medycznej w Lublinie.
Abstract: We reviewed ophthalmic manifestations in Lyme borreliosis, concentrating on clinical and laboratory diagnosis, differential diagnosis and treatment options. Ocular involvement may occur in every stage of the disease. Conjunctivitis and episcleritis are the most frequent manifestations of the early stage. Neuro-ophthalmic disorders and uveitis occur in the second stage whereas keratitis, chronic intraocular inflammation and orbital myositis have been reported in the third stage of borreliosis.
Ocular manifestations of Lyme borreliosis in Europe
Int J Med Sci 2009; 6(3):124-125. doi:10.7150/ijms.6.124 Short Communication
Mora P, Carta A.
Paolo Mora, Arturo Carta Institute of phthalmology, University of Parma - Parma (Italy)
"Ocular involvement in Lyme borreliosis, even though possible in every stage of the disease, is most frequently seen in the late phases (2nd and 3rd). In a German series of children affected by Lyme arthritis, 4% also had ocular inflammation consisting of keratitis or uveitis. In a Finnish cohort of twenty patients with ocular borreliosis, 10 had uveitis, 5 subjects showed ocular adnexa inflammation, 4 had neuro-ophthalmological alterations and one patient developed branch central retinal vein occlusion. Contact with a tick was clearly reported in only 13/20 cases. There are various ocular symptoms of Lyme disease including: pain, visual impairment, photophobia, myodesospia, diplopia and lack of accommodation."
Continue Reading this Short Communication at: http://www.medsci.org/v06p0124.htm
Optic neuropathy in children with Lyme disease.
Pediatrics. 2001 Aug;108(2):477-81.
Rothermel H, Hedges TR 3rd, Steere AC.
Source: Division of Rheumatology/Immunology, Tufts University School of Medicine, New England Medical Center, Boston, MA 02111, USA.
Abstract: Involvement of the optic nerve, either because of inflammation or increased intracranial pressure, is a rare manifestation of Lyme disease. Of the 4 children reported here with optic nerve abnormalities, 2 had decreased vision months after disease onset attributable to optic neuritis, and 1 had headache and diplopia early in the infection because of increased intracranial pressure associated with Lyme meningitis. In these 3 children, optic nerve involvement responded well to intravenous ceftriaxone therapy. The fourth child had headache and visual loss attributable to increased intracranial pressure and perhaps also to optic neuritis. Despite treatment with ceftriaxone and steroids, he had persistent increased intracranial pressure leading to permanent bilateral blindness. Clinicians should be aware that neuro-ophthalmologic involvement of Lyme disease may have significant consequences. If increased intracranial pressure persists despite antibiotic therapy, measures must be taken quickly to reduce the pressure.
Pediatrics. 2001 Aug;108(2):477-81.
Rothermel H, Hedges TR 3rd, Steere AC.
Source: Division of Rheumatology/Immunology, Tufts University School of Medicine, New England Medical Center, Boston, MA 02111, USA.
Abstract: Involvement of the optic nerve, either because of inflammation or increased intracranial pressure, is a rare manifestation of Lyme disease. Of the 4 children reported here with optic nerve abnormalities, 2 had decreased vision months after disease onset attributable to optic neuritis, and 1 had headache and diplopia early in the infection because of increased intracranial pressure associated with Lyme meningitis. In these 3 children, optic nerve involvement responded well to intravenous ceftriaxone therapy. The fourth child had headache and visual loss attributable to increased intracranial pressure and perhaps also to optic neuritis. Despite treatment with ceftriaxone and steroids, he had persistent increased intracranial pressure leading to permanent bilateral blindness. Clinicians should be aware that neuro-ophthalmologic involvement of Lyme disease may have significant consequences. If increased intracranial pressure persists despite antibiotic therapy, measures must be taken quickly to reduce the pressure.
The expanding clinical spectrum of ocular lyme borreliosis.
Ophthalmology. 2000 Mar;107(3):581-7.
Mikkilä HO, Seppälä IJ, Viljanen MK, Peltomaa MP, Karma A.
Source: Department of Ophthalmology, Helsinki University Central Hospital, Finland.
Abstract
OBJECTIVE: To delineate the clinical manifestations of ocular Lyme borreliosis, while concentrating on new symptoms and findings and the phase of appearance of ophthalmologic disorders.
DESIGN: Observational case series.
PARTICIPANTS: Ten patients with Lyme borreliosis-associated ophthalmologic findings previously reported from the Helsinki University Central Hospital in addition to 10 new cases that have since been diagnosed.
INTERVENTION/TESTING: The patients underwent medical and ophthalmologic evaluation. The diagnosis of Lyme borreliosis was based on medical history, clinical ocular and systemic findings, determinations of antibodies to Borrelia burgdorferi by enzyme-linked immunosorbent assay and immunoblot analysis, the detection of DNA of B. burgdorferi by polymerase chain reaction, and exclusion of other infectious and inflammatory causes.
MAIN OUTCOME MEASURES: Ocular complaints, presenting ophthalmologic findings, and the stage of Lyme borreliosis were recorded.
RESULTS: Four patients presented with a neuro-ophthalmologic disorder, five had external ocular inflammation, 10 patients had uveitis, and one had branch retinal vein occlusion. One patient developed episcleritis and one patient developed abducens palsy within 2 months of the infection incident. In the remaining 14 patients in whom the time of infection was traced, the ocular manifestations appeared in the late stage of Lyme borreliosis. Two patients with a neuro-ophthalmologic disorder and one with external ocular inflammation experienced severe photophobia, whereas the main reported symptom of the patients with uveitis was decreased visual acuity. Four patients with external ocular disease and one with a neuro-ophthalmologic disorder experienced severe periodic ocular or facial pain. Retinal vasculitis developed in seven patients with uveitis.
CONCLUSIONS: Lyme borreliosis can cause a variety of ocular manifestations, which develop mainly in the late stage of the disease. Photophobia and severe periodic ocular pain can be characteristic symptoms of Lyme borreliosis. In the differential diagnosis of retinal vasculitis, Lyme borreliosis should be taken into account, especially in endemic areas.
Ophthalmology. 2000 Mar;107(3):581-7.
Mikkilä HO, Seppälä IJ, Viljanen MK, Peltomaa MP, Karma A.
Source: Department of Ophthalmology, Helsinki University Central Hospital, Finland.
Abstract
OBJECTIVE: To delineate the clinical manifestations of ocular Lyme borreliosis, while concentrating on new symptoms and findings and the phase of appearance of ophthalmologic disorders.
DESIGN: Observational case series.
PARTICIPANTS: Ten patients with Lyme borreliosis-associated ophthalmologic findings previously reported from the Helsinki University Central Hospital in addition to 10 new cases that have since been diagnosed.
INTERVENTION/TESTING: The patients underwent medical and ophthalmologic evaluation. The diagnosis of Lyme borreliosis was based on medical history, clinical ocular and systemic findings, determinations of antibodies to Borrelia burgdorferi by enzyme-linked immunosorbent assay and immunoblot analysis, the detection of DNA of B. burgdorferi by polymerase chain reaction, and exclusion of other infectious and inflammatory causes.
MAIN OUTCOME MEASURES: Ocular complaints, presenting ophthalmologic findings, and the stage of Lyme borreliosis were recorded.
RESULTS: Four patients presented with a neuro-ophthalmologic disorder, five had external ocular inflammation, 10 patients had uveitis, and one had branch retinal vein occlusion. One patient developed episcleritis and one patient developed abducens palsy within 2 months of the infection incident. In the remaining 14 patients in whom the time of infection was traced, the ocular manifestations appeared in the late stage of Lyme borreliosis. Two patients with a neuro-ophthalmologic disorder and one with external ocular inflammation experienced severe photophobia, whereas the main reported symptom of the patients with uveitis was decreased visual acuity. Four patients with external ocular disease and one with a neuro-ophthalmologic disorder experienced severe periodic ocular or facial pain. Retinal vasculitis developed in seven patients with uveitis.
CONCLUSIONS: Lyme borreliosis can cause a variety of ocular manifestations, which develop mainly in the late stage of the disease. Photophobia and severe periodic ocular pain can be characteristic symptoms of Lyme borreliosis. In the differential diagnosis of retinal vasculitis, Lyme borreliosis should be taken into account, especially in endemic areas.
What kind of clinical, epidemiological, and biological data is essential for the diagnosis of Lyme borreliosis? Dermatological and ophtalmological courses of Lyme borreliosis. [Article in French]
Med Mal Infect. 2007 Dec;37 Suppl 3:S175-88. Epub 2007 Dec 11.
Boyé T.
Source: Service de dermatologie, hôpital d'instruction des armées Legouest, 27,
avenue de Plantières, BP10, 57998 Metz Armées, France. [email protected]
Abstract: Lyme borreliosis (BL) is a multisystem infectious tick-transmitted disease. The diversity of Borrelia burgdorferi is the reason for a wide spectrum of dermatological and ophthalmologic presentations between patients from Europe and from other countries. In Europe, the main manifestations are dermatological. During the early stage, the diagnosis is clinical: finding erythema migrans (EM) a few days after a tick bite is sufficient; several EM mean an early-disseminated disease. Borrelial lymphocytoma (only in Europe) is a solitary nodule or plaque (earlobe, nipple, scrotum), which appears during the second stage. The diagnosis relies on clinical and histological findings (B-cell infiltration) and a positive serological test. It is sometimes difficult to make the difference between BL and B-cell lymphoma and pseudo lymphoma; an empirical antibiotic trial period will be helpful for the diagnosis in this case. During the late stage, the clinical evolution of acrodermatitis chronica atrophicans is progressive: inflammatory then atrophic lesions appear, often on the hands, limbs, or feet. The diagnosis is made on histological findings (T-cell infiltration) and a positive serological test. The relationship between BL and morphea or lichen sclerosus was not demonstrated according to the latest reports. Ocular manifestations are rare events occurring during every stage of the disease. A wide spectrum of presentations is possible (uveitis and optic neuritis). BL is responsible for ocular infection or inflammation. A neurological presentation is often associated with the ocular manifestation. Proving the diagnosis is often difficult because of these polymorphous manifestations.
Med Mal Infect. 2007 Dec;37 Suppl 3:S175-88. Epub 2007 Dec 11.
Boyé T.
Source: Service de dermatologie, hôpital d'instruction des armées Legouest, 27,
avenue de Plantières, BP10, 57998 Metz Armées, France. [email protected]
Abstract: Lyme borreliosis (BL) is a multisystem infectious tick-transmitted disease. The diversity of Borrelia burgdorferi is the reason for a wide spectrum of dermatological and ophthalmologic presentations between patients from Europe and from other countries. In Europe, the main manifestations are dermatological. During the early stage, the diagnosis is clinical: finding erythema migrans (EM) a few days after a tick bite is sufficient; several EM mean an early-disseminated disease. Borrelial lymphocytoma (only in Europe) is a solitary nodule or plaque (earlobe, nipple, scrotum), which appears during the second stage. The diagnosis relies on clinical and histological findings (B-cell infiltration) and a positive serological test. It is sometimes difficult to make the difference between BL and B-cell lymphoma and pseudo lymphoma; an empirical antibiotic trial period will be helpful for the diagnosis in this case. During the late stage, the clinical evolution of acrodermatitis chronica atrophicans is progressive: inflammatory then atrophic lesions appear, often on the hands, limbs, or feet. The diagnosis is made on histological findings (T-cell infiltration) and a positive serological test. The relationship between BL and morphea or lichen sclerosus was not demonstrated according to the latest reports. Ocular manifestations are rare events occurring during every stage of the disease. A wide spectrum of presentations is possible (uveitis and optic neuritis). BL is responsible for ocular infection or inflammation. A neurological presentation is often associated with the ocular manifestation. Proving the diagnosis is often difficult because of these polymorphous manifestations.
Lyme disease: neurologic and ophthalmic manifestations
Surv Ophthalmol. 1990 Nov-Dec;35(3):191-204.
Winterkorn JM.
Source: Department of Ophthalmology, North Shore University Hospital-Cornell
University Medical College, Manhasset, New York.
Abstract: Lyme disease is tick-borne infection which produces early and late manifestations in many organ systems. Prominent symptoms and signs occur in skin, heart, joints and nervous system. Many ocular and neuro-ophthalmic abnormalities recently have been attributed to Lyme disease, but some cases have not been well established as direct sequelae. This review of the contemporary state of knowledge about Lyme disease was undertaken so that more rigorous criteria can be applied in future diagnosis.
Surv Ophthalmol. 1990 Nov-Dec;35(3):191-204.
Winterkorn JM.
Source: Department of Ophthalmology, North Shore University Hospital-Cornell
University Medical College, Manhasset, New York.
Abstract: Lyme disease is tick-borne infection which produces early and late manifestations in many organ systems. Prominent symptoms and signs occur in skin, heart, joints and nervous system. Many ocular and neuro-ophthalmic abnormalities recently have been attributed to Lyme disease, but some cases have not been well established as direct sequelae. This review of the contemporary state of knowledge about Lyme disease was undertaken so that more rigorous criteria can be applied in future diagnosis.
