Lyme Disease and the eyes

Topics with information and discussion about published studies related to Lyme disease and other tick-borne diseases.
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Mon 12 Nov 2007 11:06

1: J Neuroophthalmol. 2007 Jun;27(2):123-4. Links
Lyme disease associated with postganglionic horner syndrome and raeder paratrigeminal neuralgia.Murphy MA, Szabados EM, Mitty JA.
Departments of Ophthalmology (MAM), Neurology (EMS), and Infectious Disease (JAM), Rhode Island Hospital, Brown Medical School, Providence, Rhode Island.

ABSTRACT:: A 55-year-old woman developed severe unilateral headaches, periocular numbness, and Horner syndrome after presenting with symptoms consistent with Lyme disease. The combination of Horner syndrome and periocular headache and numbness constituted a diagnosis of Raeder paratrigeminal neuralgia. Although the headaches resolved with antibiotic treatment, the Horner syndrome persisted for at least 1 year. This case expands the spectrum of neurologic manifestations of Lyme disease to include postganglionic Horner syndrome as well as Raeder paratrigeminal neuralgia.

PMID: 17548997
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Mon 12 Nov 2007 11:06

Med Mal Infect. 2007 Mar 19;
[Ocular manifestations of Lyme disease.


Bodaghi B.
Service d'ophtalmologie, université Paris-VI, CHU de la Pitié-Salpêtrière, 47–83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.

Despite the wide spectrum of clinical entities, eye involvement remains a rare event in patients with Lyme borreliosis. Most of ocular manifestations occur during the late phase of the disease. The infection needs to be considered along with more conventional causes of ocular inflammation, particularly in regions where Lyme disease is common. The pathogenesis of this condition remains controversial. Direct ocular infection and a delayed hypersensitivity mechanism may be involved at different disease stages. Uveitis and optic neuritis are the most common ocular complications. Serological testing lacks sensitivity and specificity. In atypical cases, ocular fluids sampling and analysis may be proposed. PCR seems to be an interesting diagnostic tool, allowing genotypic analysis. In the majority of cases, therapeutic strategy should be based on the association of antibiotics and corticosteroids. A new course of antibiotics may be prescribed to patients with chronic or relapsing inflammation due to bacterial persistence in ocular tissues.

PMID: 17376626
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Mon 12 Nov 2007 11:07

Klin Mikrobiol Infekc Lek. 2007 Jun;13(3):122-5.
[Eye involvement of borrelia aetiology][Article in Czech]


Krbková L, Vodicková K, Pellarová H, Bednárová J, Cápová I.
Medical Faculty, Masaryk University, Clinic of Chilren's Infectious Diseases, Brno, Czech Republic. lkrbkova@fnbrno.cz

We present a case of eye involvement -- intermediate uveitis -- during tick-borne borreliosis in a 10-year-old boy. Ophthalmologic examination revealed impaired vision, apparent thick floating whitish opacity in the vitreous humour of the left eye and fine fibres in the vitreous humour of the right eye. Sonographic examination confirmed hyperechogenic opacity in the vitreous humour. An autoimmune process was suspected but not confirmed. Serological examination showed IgG antibodies against three pathogenic borreliae and borderline values of IgM antibodies against Borrelia garinii were found by immunoblot. The boy was treated with intravenous ceftriaxone for 21 days. The subsequent sonographic examination showed only minute sporadic echogenicity. Biomicroscopically, only residual opacity in the vitreous humour was found. Isolated eye involvement of borrelia aetiology is rare. The discussion provides a review of similar cases of uveitis including diagnosis of the eye form as published in literature.

PMID: 17703406
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Sun 18 Nov 2007 10:48

1: J Neuroophthalmol. 1994 Jun;14(2):77-80.Links
Transient worsening of optic neuropathy as a sequela of the Jarisch-Herxheimer reaction in the treatment of Lyme disease.Strominger MB, Slamovits TL, Herskovitz S, Lipton RB.
Department of Ophthalmology, Montefiore Medical Center, Bronx, NY 10467.

A 58-year-old woman developed neurologic and neuroophthalmologic manifestations of Lyme disease, including a radiculomyelitis, cranial neuritis and mild right optic neuropathy. Upon treatment with intravenous ceftriaxone a Jarisch-Herxheimer reaction occurred with encephalopathy, mild fever, worsening radiculomyelitis, and deterioration of her visual acuity. Intravenous methylprednisolone was given, and the visual acuity recovered over 72 hours. This case suggests that transient worsening of optic neuropathy can develop as a sequela of the Jarisch-Herxheimer reaction in the treatment of Lyme disease.

PMID: 7951931
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Sun 25 Nov 2007 21:17

Opsoclonus–myoclonus as a manifestation of Lyme disease

L Peter1, J Jung1, C Tilikete2, P Ryvlin1, F Mauguiere1

1 Service de Neurologie et d’épileptologie, Hôpital Neurologique, Lyon, France
2 Service de Neuro-ophtalmologie, Hôpital Neurologique


Correspondence to:
Correspondence to:
L Peter
Service de Neurologie et d’Epileptologie, Hôpital Neurologique, 59 Boulevard Pinel, 69003 Lyon, France;laure.peter@wanadoo.fr


ABSTRACT
Opsoclonus–myoclonus syndrome (OMS) is a rare condition that includes chaotic multidirectional saccadic eye movements associated with myoclonus and ataxia. In adults, it is usually considered to be an autoimmune disease occurring either in a paraneoplastic context or after central nervous system infection. We report the case of a patient who presented with the classic features of OMS as a manifestation of acute Borrelia burgdorferi infection that was shown both on serum and cerebrospinal fluid examination. The outcome was favourable after prolonged antibiotic treatment. Lyme disease could be added to the list of aetiologies to be screened in OMS, as it would allow effective treatment and avoidance of unnecessary investigations.

http://jnnp.bmj.com/cgi/content/abstract/77/9/1090
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Sat 29 Dec 2007 16:34

Lyme uveitis an uncommon but treatable condition

Source: Ophthalmology Times

By: Emmett T. Cunningham, Jr., MD, PhD, MPH
Originally published: October 1, 2004

Who gets Lyme uveitis, and what are the historical and clinical clues that help make the diagnosis?

Emmett T. Cunningham Jr., MD, PhD, MPH: Lyme uveitis is undoubtedly uncommon. In nearly 10 years of seeing almost exclusively patients with ocular inflammatory disorders, I have made the diagnosis of Lyme uveitis less than 10 times. That said, I hate to miss the diagnosis since it is one of the few forms of uveitis where prompt and appropriate treatment can actually cure the vast majority of patients.

In my mind, Lyme uveitis is like syphilis in that it can present in almost any fashion—anterior uveitis, intermediate uveitis, diffuse or panuveitis, retinitis, retinal vasculitis, neuroretinitis, multifocal choroiditis, etc. It can also cause scleritis, episcleritis, or an ocular nerve palsy. Since in isolation any of these clinical findings is fairly nonspecific, I tend to be most suspicious of Lyme disease when patients live in, or have traveled to, areas where the disease is endemic, when there is a history of tick exposure, or when they have, or have had, symptoms consistent with systemic Borrelia infection

Bahram Bodaghi, MD, PhD:

The late phase is known as stage 3 (persistent). Intraocular manifestations of Lyme disease usually develop during the late stage of disease. They show characteristics resembling those seen in patients with syphilis. Intermediate and posterior uveitis are the types most frequently reported in the past few years. Cystoid macular edema, vitritis, optic neuritis, retinal vasculitis, and retinal vascular occlusions are the major complications of the disease.

J. Michael Jumper, MD: Lyme uveitis can occur in any person exposed to the tick vector carrying the spirochete B burgdorferi. This occurs most commonly in children under 15 and adults from 30 to 60 years of age.

Is Lyme uveitis due to direct infection of the eye by the spirochete or to a secondary immune reaction?

Dr. Walton: It remains unclear whether Lyme uveitis is due to direct infection by B burgdorferi or to the associated immune response to the organism. Providing support for a direct infectious cause are reports that have documented the presence of spirochetes in eyes with uveitis. Additionally, many patients' uveitis resolves following completion of antibiotic therapy.

On the other hand, a number of patients have persistent uveitis despite antibiotic therapy and negative serologic tests. This may be due to small numbers of persistent organisms or to the host's immune response. Both humoral and cellular immune responses may be important in the pathogenesis of uveitis. Furthermore, recent evidence suggests that molecular mimicry may play a role in chronic Lyme arthritis, and this may represent another mechanism for the development of uveitis in these patients.

Dr. Cunningham:

I usually start, therefore, by treating all patients with clinically suspected or serologically supported Lyme uveitis with a course of systemic antibiotics in combination with a topical corticosteroid, such as prednisolone acetate, 1%, and a topical cycloplegic/mydriatic agent, such as scopolamine, 0.25%, or homatropine, 2% to 5%. It is important to remember that paradoxical worsening, or the so-called Jarisch-Herxheimer reaction, has been described in both systemic and ocular Lyme disease,2 just as it has been reported in patients with syphilis. Therefore, some patients with severe ocular inflammation may require concomitant treatment with oral prednisone

Dr. Jumper: As with Treponema pallidum, the other spirochete known to infect the eye and cause uveitis, Lyme uveitis likely represents an immune reaction to direct infection of the ocular tissues. Bacterial DNA has been found in the vitreous of an infected patient by polymerase chain reaction (PCR), and histologic study has shown spirochetes in the ocular tissues in a patient with choroiditis and vitritis. Some ophthalmic manifestations may represent an autoimmune reaction because antiaxonal antibodies have been found in patients with Lyme disease and neurologic manifestations.

Dr. Bodaghi: The pathogenesis of the disease remains controversial. Direct ocular infection and a delayed hypersensitivity mechanism may be involved at different times during the disease. The spirochete can invade the eye early and remain latent in some cases, accounting for both early and late ocular manifestations. Steere et al. reported direct infection of the eye with unilateral panophthalmitis occurring 4 weeks after the onset of erythema migrans. Interestingly, diagnostic vitrectomy confirmed the presence of spirochetes in the vitreous.

http://actmagazine.mediwire.com/main/De ... eID=128509
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Tracy9
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Re: Lyme Disease and the eyes

Post by Tracy9 » Mon 31 Dec 2007 1:07

Help! Can you describe simply what these mean? All the symptoms are medical terms.

My husband has had red eyes since he got lyme; he looks like he is on drugs. Is this common?

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Re: Lyme Disease and the eyes

Post by LymeEnigma » Mon 31 Dec 2007 21:44

Tracy, I have read that Lyme can cause conjunctivitis (irritation and/or infection of the whites of the eyes).

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Re: Lyme Disease and the eyes

Post by Tracy9 » Tue 1 Jan 2008 7:09

Well, it's not conjuntivitis; he has had it for years. The eye doctor called it roseacea of the eyes.

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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Tue 1 Jan 2008 19:57

Tracy9 wrote:
My husband has had red eyes since he got lyme; he looks like he is on drugs. Is this common?
I have more often read or heard about it.

I had conjunctivitis every month for a number of years.
Well, it's not conjuntivitis; he has had it for years. The eye doctor called it roseacea of the eyes.
I read this about roseacea:

Q: Patient 1: Has ocular rosacea, full-blown blepharitis, including swelling and distorted area around eyes and eyelids, gritty feeling and tearing in the eyes. Cannot take doxycycline antibiotics because they're contraindicated for the drugs prescribed for a serious case of Lyme disease. Could you recommend any treatment she might suggest to her eye specialist, and do you know if Lyme disease has any impact on ocular rosacea?

A: There is not ... aside from the fact that both are generalized inflammatory diseases, there is no interaction between Lyme infection and ocular rosacea that we are aware of. Are they able to take any antibiotics? Do we know what has been tried? To answer questions intelligently that are very patient specific, I would need to know more details about the patient. It's difficult for me to speak about specific patients.

http://www.rosacea-research.org/wiki/in ... Mannis,_MD

And this:

http://www.acne-rosacea-relief.com/ocular_rosacea.html
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