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 » Tue 1 Jan 2008 19:59

How does lyme disease affect the eye?
Fortunately, involvement of the eye is uncommon in lyme disease. But when the eyes can be affected in many different ways by the disease.

In the early stage of the disease, many persons have conjunctivitis. In this condition, commonly called pink eye, the eyes are red and uncomfortable, and there is a discharge of pus. Unlike many forms of conjunctivitis, the type that occurs in lyme disease is not contagious.

In later stages of the disease, inflammation of the eye may develop. Parts of the eye that may be affected include the uvea, the middle layer inside the eye, the cornea, part of the outer coat of the eye; the iris, the colored circle around the pupil, and the choroid, a layer of blood vessels in the eye. Ocular symptoms can include sensitivity to light and floaters (spots in front of the eyes).

Inflammation of the optic nerve (optic neuritis) also can occur, which results in visual loss. Loss of vision can result from inflammation in the brain as well.

Persons who develop Bell’s palsy may be unable to blink or close their eyes. This dries the cornea and can result in an infection or even a hole in the cornea, which can endanger vision if not treated promptly.

http://www.uic.edu/com/eye/LearningAbou ... ease.shtml
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Mon 14 Jan 2008 21:13

1: Ophthalmologe. 1997 Aug;94(8):591-4. Links

Acute Borrelia infection. Unilateral papillitis as isolated clinical manifestation
[Article in German]


Pradella SP, Krause A, Müller A.
Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität, Halle-Wittenberg.

BACKGROUND: Borrelia burgdorferi is the cause of erythema chronicum migrans and Lyme disease. Ticks like Ixodes ricinus are responsible for transmission. Frequently, the tick bite is not noticed by the patient. Eye manifestations, such as keratoconjunctivitis, scleritis, chronic uveitis, vitritis, chorioretinitis, optic nerve disease, orbital myositis and paresis of the eye muscles, often occur after a long period of time and vary greatly. PATIENTS AND METHODS: We present below the case reports of a man 38 years old and a woman of 31, each with manifestation of an ocular Borrelia infection (papillitis and panuveitis, respectively). RESULTS: By antibody-screening with the ELISA technique and Western Blot analysis we were able to prove the serological infection. After specific antibiotic therapy, ocular inflammation improved rapidly, as did visual acuity. The papillitis only healed partially. CONCLUSIONS: In case of therapy-resistant inflammation of the eye we have to exclude general infections because cortisone therapy alone may result in worsening the condition. VECP can be used effectively in the differential diagnosis of papilloedemas. Early diagnosis and therapy of an acute Borrelia infection restrict the extent of the lesions and prevent ocular and general late manifestations. Seronegative values in subjects strongly suspected of having Lyme disease do not necessarily exclude the diagnosis of Lyme disease.

PMID: 9376700
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Mon 14 Jan 2008 21:14

Retina. 1996;16(6):505-9.Links

Long-term follow-up of chronic Lyme neuroretinitis.

Karma A, Stenborg T, Summanen P, Immonen I, Mikkilä H, Seppälä I.
Department of Ophthalmology, University of Helsinki, Finland.

PURPOSE: The authors report sequential fluorescein angiographic and color photographic findings of the fundi and response to treatment in a patient with chronic Lyme neuroretinitis. METHODS: A Lyme enzyme-linked immunosorbent assay with purified 41-kd flagellin as antigen was used to detect immunoglobulin G and immunoglobulin M antibodies to Borrelia burgdorferi in serum, cerebrospinal fluid, and vitreous. The changes were documented by fluorescein angiography and color photography tests performed during a 5 1/2 year follow-up. RESULTS: The diagnosis of Lyme neuroretinitis was based on the history of erythema migrans and positive Lyme enzyme-linked immunosorbent assay tests from cerebrospinal fluid and vitreous and by the exclusion of other infectious and systemic diseases and uveitis entities. Fluorescein angiography results disclosed bilateral chronic neuroretinal edema with areas of cystoid, patchy, and diffuse hyperfluorescence peripapillary and in the macular areas. The hyperfluorescent lesions enlarged despite a 9-month period of antibiotic therapy. CONCLUSION: Lyme borreliosis may cause neuroretinitis with unusual angiographic findings. Chronic Lyme neuroretinitis may be unresponsive to antibiotic therapy.

PMID: 9002133
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Mon 14 Jan 2008 21:15

Acta Ophthalmol Scand. 1997 Dec;75(6):716-9.Links

The etiology of uveitis: the role of infections with special reference to Lyme borreliosis.

Mikkilä H, Seppälä I, Leirisalo-Repo M, Immonen I, Karma A.
Department of Ophthalmology, University of Helsinki, Finland.

PURPOSE: To assess the distribution of different uveitis entities and to evaluate their associations with infections, especially Lyme borreliosis. METHODS: During a one-year period 160 consecutive uveitis patients were evaluated in a university clinic. Selected tests were performed depending on the medical history of the patient and the clinical picture of the ocular inflammation. RESULTS: Uveitis was classified into selected entities for 74.4% of the patients. A direct infection was suggested to be linked with uveitis in 23 patients (14.4%). Lyme borreliosis, toxoplasmosis, and herpetic infections were the most frequently seen, in seven patients (4.3%) each. All patients with Lyme uveitis had manifestations of the posterior segment of the eye, such as vitritis, retinal vasculitis, neuroretinitis, chorioretinitis, or optic neuropathy. CONCLUSION: Infections are an important cause of uveitis in a university clinic. Lyme borreliosis is a newly recognised uveitis entity which should be kept in mind in the differential diagnosis of intermediate or posterior uveitis in areas endemic for Lyme borreliosis.

PMID: 9527338
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Re: Lyme Disease and the eyes

Post by Yvonne » Thu 17 Jan 2008 10:51

1: Cesk Slov Oftalmol. 1995 Feb;51(1):34-8. Links

Anterior uveitis in Lyme borreliosis
[Article in Czech]


Rícarová R, Struncová V, Plísková S, Jurcuková M.
Ocní klinika LF UK, Plzen.

The authors present an account of two patients with anterior uveitis in the second stage of Lyme borreliosis. The draw attention to diagnostic problems of the disease from the ophthalmological aspect.

PMID: 7736621
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Re: Lyme Disease and the eyes

Post by Yvonne » Thu 17 Jan 2008 10:58

Klin Monatsbl Augenheilkd. 1989 Feb;194(2):88-96. Links

Bilateral acute confluent disseminated choroiditis in Borrelia burgdorferi infection
[Article in German]


Wilk CM, Bialasiewicz AA, Ruprecht KW, Naumann GO.

Augenklinik mit Poliklinik, Universität Erlangen-Nürnberg.

Two patients with bilateral extensive confluent choroidal lesions, exudative retinal detachments, positive lyme serology and a typical history are documented: A 32-year-old woman presented 14 days after a "flu-like" illness with bilateral acute extensive choroidal lesions and exudative retinal detachments (OD from 5 to 8:30 o'clock, OS from 5 to 8 o'clock, both including the macula) accompanied by a mild lymphocytic meningitis. The laboratory work-up revealed increased serum and CSF titers of antibodies against Borrelia burgdorferi (Lyme immunofluorescent test (IFT) and Lyme-IgM IFT) which declined after a 14-day treatment with doxycycline (200 mg/d), CSF titers non-detectable (serum IgG: from 1:640 to 1:320, serum IgM: from 1:40 to 1:20). A distinct improvement with visual acuity increasing from OD 0.2/OS 0.3 p to OD/OS 0.8 p was observed after seven days of treatment. A 40-year-old man with a 14-day history of tick-bite developed the same, though more severe ocular findings and a lymphocytic meningitis. The serological work-up revealed increased antibody titers against Borrelia burgdorferi (ELISA); the IgM titer was normal. After a 10-day treatment with penicillin, antibody titers against the spirochete decreased slightly and the patient's neurologic and ophthalmologic status improved dramatically. Five weeks after admission visual acuity was OD/OS 0.5 (compared to OD/OS 0.1) and has remained at 0.8 p (OD/OS) since the ninth week after onset. The clinical course of the disease and the decreasing lyme serology strongly suggest an infection with Borrelia burgdorferi. The authors propose thorough laboratory work-ups including tests for Lyme disease in selected patients with diffuse choroidal lesions.

PMID: 2716229
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Re: Lyme Disease and the eyes

Post by Yvonne » Thu 17 Jan 2008 11:07

J Fr Ophtalmol. 2005 Dec;28(10):1095-100

Onset of Leber's hereditary optic neuropathy in association with borreliosis
[Article in French]


Macarez R, Bazin S, Lagauche D, Soullié B, Giordano P, May F, Guigon B.
Service d'Ophtalmologie, HIA Clermont Tonnerre, BP 41, 29240 Brest-Armées.

INTRODUCTION: The diagnosis of Lyme disease in the presence of an acute optical neuritis always raises a difficult diagnostic problem. We present a case of Lyme-associated Leber's hereditary optic neuropathy (LHON). OBSERVATION: A 17-year-old Eurasian young man presented with left-eye visual impairment for 1 month. This loss of vision acuity in the left eye is related to an optic neuropathy. Mitochondrial DNA testing showed a G to A substitution at position 11778 confirming a diagnosis of LHON. The family history disclosed a case of LHON in a maternal cousin. The mother's family is Asian. Besides, serum examination of anti-Borrelia antibodies was performed and was positive against Borrelia burgdorferi garinii. The patient history indicated that he had been possessing a dog and was living in an endemic area of Lyme disease. But he did not recall receiving a tick bite nor having any erythema chronicum migrans. Initial examination showed bilateral green-red axis colour vision defects which made us fear bilateralisation of the optic neuropathy, which occurred 2 months later (that is 3 months after the onset of symptoms on the left eye). An antibiotic treatment by ceftriaxone was administered for 4 weeks all in all; and a long term ubidecarenone therapy was established. At present, after a 1-year follow up, the eyes' conditions remains unchanged. CONCLUSION: To our knowledge, this would be the first case reporting such an association, in which we can discuss the fortuitous character or the role of the infectious factor in the developing of the mitochondrial pathology. This observation also raises the problem of the positive diagnosis of Lyme disease when tick bite and erythema are absent or underestimated.

PMID: 16395203
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Re: Lyme Disease and the eyes

Post by Yvonne » Thu 17 Jan 2008 11:09

Cornea. 1999 Jan;18(1):115-6.

Lyme disease associated with unilateral interstitial keratitis.
Miyashiro MJ, Yee RW, Patel G, Ruiz RS.
Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, 77030, USA.

PURPOSE: To report a case of Lyme disease that presented with a single nummular unilateral interstitial keratitis. METHODS: Case report and review of the literature. RESULTS: A 57-year-old black man who had contact with freshly killed deer had a chief complaint of foreign-body sensation in his right eye (OD) that had been diagnosed and treated for herpes simplex stromal keratitis. The patient underwent a systemic workup for interstitial keratitis. All results including RPR and MHA-TP were negative except for Lyme antibody titer (enzyme-linked immunosorbent assay [ELISA]) 178 U/ml (normal, <159 U/ml). CONCLUSION: Interstitial keratitis from Lyme disease has been regarded as a bilateral disease in the literature. We present this infrequent ocular manifestation of Lyme disease as a rare single nummular unilateral presentation.

PMID: 9894947
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Re: Lyme Disease and the eyes

Post by Yvonne » Fri 18 Jan 2008 9:50

Arq Bras Oftalmol. 2005 May-Jun;68(3):381-4. Epub 2005 Jul 26. Links

Bilateral tonic pupil as the only remaining ophthalmic sign of Lyme disease: case report.
[Article in Portuguese]


Fugimoto F, Ghanem RC, Monteiro ML.
Clínica Oftalmológica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. ffugimoto@yahoo.com.br

Lyme disease is a multisystemic disorder caused by Borrelia burgdorferi spirochete, transmitted by ticks. Mainly described in the northern hemisphere and rarely in Brazil. The purpose of this report is to describe a patient with Lyme disease who developed bilateral tonic pupil as the only remaining sign. A 13-year-old female with Lyme disease, presented with bilateral peripheral facial and oculomotor paralysis. After recovery from neurological abnormalities the patient sustained anisocoria, reduced fotomotor reflex, less than normal amplitude of accommodation, tonic pupil constriction for near objects and slow redialation in both eyes. Dilute 0.1% pilocarpine test was positive in both eyes, confirming the suspicion of bilateral tonic pupil. This is the first case report of bilateral tonic pupil caused by Lyme disease.

PMID: 16059573
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Re: Lyme Disease and the eyes

Post by Yvonne » Tue 22 Jan 2008 20:23

Klin Monatsbl Augenheilkd. 1992 Aug;201(2):83-91. Links

Ocular findings in infection with Borrelia burgdorferi

Article in German]


Reim H, Reim M.
Augenklinik, Medizinischen Fakultät, Rheinisch-Westfälischen Technischen Hochschule Aachen.

During the years 1988 to 1990 ten patients were observed in the eye clinic of RWTH Aachen with ocular findings of infection with Borrelia burgdorferi. 6 of them showed neuro-ophthalmological signs, 4 had uveitis. In both groups recent infections were documented in fresh and chronic stages of the disease, lasting longer than one year. The various clinical pictures of the disease following infection with Borrelia burgdorferi are described. As a vaccination against Borreliosis is not yet available, it is important to detect the antibodies against Borrelia burgdorferi early enough, to initiate an effective treatment.
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