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 22 Jan 2008 20:24

Klin Monatsbl Augenheilkd. 1991 Jan;198(1):44-7. Links

Bilateral Leber's neuroretinitis stellata in Borrelia burgdorferi seroconversion

[Article in German]


Schönherr U, Lang GE, Meythaler FH.
Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg.

We report on a 22-year-old white female with bilateral Leber's stellate neuroretinitis occurring 5 weeks after a viral-like illness. Serological tests revealed a seroconversion for Borrelia burgdorferi indicating an etiological connection. During therapy with 200 mg doxycycline daily for 2 weeks on systemically steroids the optic disc swelling and macular star figure resolved. Visual acuity improved from 0.4 to 1.0 in this time period. It is important that the ophthalmologist should consider Lyme-Borreliosis in isolated neuroretinitis, because the prognosis depends on the time when treatment is initiated.

PMID: 2023374
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Tue 5 Feb 2008 10:21

1: Graefes Arch Clin Exp Ophthalmol. 2008 Jan 12 [Epub ahead of print] Links

Intravitreal triamcinolone for macular edema in Lyme disease.

Reibaldi M, Faro S, Motta L, Longo A.
Eye Clinic, University of Catania, via Santa Sofia 78, Catania, Italy, ant-longo@libero.it.

BACKGROUND: To describe the outcome in a patient with macular edema caused by Lyme disease treated with injection of 4 mg intravitreal triamcinolone. METHODS: The patient, 2 years after systemic Lyme disease treated with doxycycline for 4 weeks, developed macular edema with serous retinal detachment in one eye (visual acuity: 0.6). After unsuccessful therapy with intravenous ceftriaxone, indomethacin and acetazolamide, 4 mg intravitreal triamcinolone (IVTA) was injected via the pars plana. RESULTS: Visual acuity improved to 1.0 and macular thickness recovered over 1 month. No changes were found in intraocular pressure. No recurrence of macular edema was seen after 2 years. CONCLUSIONS: IVTA can restore visual acuity and reduce macular thickness in macular edema caused by Lyme disease. However, since borreliosis is a systemic disease, previous systemic antibiotic treatment is recommended.

PMID: 18193264
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cave76
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Re: Lyme Disease and the eyes

Post by cave76 » Tue 5 Feb 2008 16:36

Thanks to Yvonne for these.

I was beginning to worry that you had stopped posting at LE----that would have been a great loss.

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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Tue 5 Feb 2008 21:55

Thank you Cave.

Don't worry, nobody is indispensable. There will always be an another "Yvonne"

But provisionally I hope I will still be here :)
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Thu 7 Feb 2008 14:36

Klin Monatsbl Augenheilkd. 1990 Jun;196(6):481-3. Links

Choriocapillaritis (so-called pigment epitheliitis) in Borrelia burgdorferi seroconversion
[Article in German]


Bialasiewicz AA, Schönherr U.
Univ.-Augenklinik mit Poliklinik der Friedrich-Alexander-Universität Erlangen-Nürnberg.

A significant B. burgdorferi seroconversion with an IgM of 1:80 was observed in a patient complaining of loss of vision in his right eye. The finding correlated morphologically with hyperpigmentation and depigmentation in the macular region, similar to pigment epitheliitis or choriocapillaritis. In the course of the following four weeks the IgM decreased by four titer steps. The visual acuity of the patient's right eye recovered from 0.4 on admission to 1.0 on discharge. The angiogram did not reveal any pathology. Since choroidal manifestations have often been documented in patients with B. burgdorferi infections, it is recommended that serological workups be performed in such patients. Studies in larger groups of patients are necessary to establish the relevance of this case report and its significance concerning infection as a cause of choriocapillaritis.

PMID: 2376946
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Sun 10 Feb 2008 9:56

Am J Ophthalmol. 1995 Feb;119(2):127-35. Links
Comment in:
Am J Ophthalmol. 1995 Aug;120(2):263-4.

Diagnosis and clinical characteristics of ocular Lyme borreliosis.

Karma A, Seppälä I, Mikkilä H, Kaakkola S, Viljanen M, Tarkkanen A.
Department of Ophthalmology, University of Helsinki, Finland.

PURPOSE: To establish a diagnosis, in a group of patients we studied the characteristics of ocular Lyme borreliosis. METHODS: During a two-year period, 236 patients with prolonged external ocular inflammation, uveitis, retinitis, optic neuritis, or unexplained neuro-ophthalmic symptoms were examined for Lyme borreliosis. Antibodies to Borrelia burgdorferi were measured by indirect ELISA and western blot. Cerebrospinal fluid was also analyzed by polymerase chain reaction. RESULTS: Ocular Lyme borreliosis was diagnosed in ten patients on the basis of medical history, clinical findings, and serologic test results. Results of ELISA disclosed that five patients were seropositive, two patients showed borderline reactivity, and three patients were seronegative. Four of the five patients with borderline or negative results by ELISA had a positive result by western blot analysis. In one seropositive patient, polymerase chain reaction verified a gene of B. burgdorferi endoflagellin from the vitreous and cerebrospinal fluid specimen. In five of the six patients with known onset of the Borrelia infection, the ocular disorder appeared as a late manifestation. Abnormalities of the posterior segment of the eye, such as vitreitis, retinal vasculitis, neuroretinitis, choroiditis, and optic neuropathy were seen in six patients. Bilateral paralytic mydriasis, interstitial keratitis, episcleritis, and anterior uveitis were seen in one patient each. CONCLUSIONS: Late-phase ocular Lyme borreliosis is probably underdiagnosed because of weak seropositivity or seronegativity in ELISA assays. Ocular borrelial manifestations show characteristics resembling those seen in syphilis.

PMID: 7832219
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Sun 10 Feb 2008 9:59

Am J Ophthalmol. 2006 Aug;142(2):348-9. Links

Borrelia hermsii causing relapsing Fever and uveitis.

Lim LL, Rosenbaum JT.
Ocular Inflammatory Diseases Unit, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon 97239, USA. liml@ohsu.edu

PURPOSE: To describe a case of uveitis that is associated with Borrelia hermsii relapsing fever. DESIGN: Interventional case report. METHODS: A 12-year-old boy with two weeks of relapsing fevers 10 days after camping in remote eastern Oregon was examined. Borrelia hermsii immunoglobulin M and G levels were markedly elevated. Intravenous ceftriaxone, followed by four weeks of oral cephuroxime was administered, but the patient developed unilateral floaters and blurred vision in association with anterior and intermediate uveitis. RESULTS: Doxycycline was administered for presumed residual infection. Four weeks later, the visual acuity had improved. The anterior chamber was quiet, and topical corticosteroid was tapered successfully. CONCLUSION: Although rare, Borrelia hermsii should be included in the list of spirochetal diseases that are associated with uveitis.

PMID: 16876531
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Sun 10 Feb 2008 10:00

Klin Monatsbl Augenheilkd. 1998 Dec;213(6):351-4. Links

Pars plana vitrectomy in Borrelia burgdorferi endophthalmitis
[Article in German]


Meier P, Blatz R, Gau M, Spencker FB, Wiedemann P.
Klinik und Poliklinik für Augenheilkunde der Universität Leipzig.

BACKGROUND: Ocular manifestations of Lyme borreliose present with unusual forms of conjunctivitis, keratitis, optic nerve disease, uveitis, vitritis and rarely endophthalmitis. CASE REPORT: A 57-year-old man working as logger in Sax-ony-Anhalt suffering from an endophthalmitis on his left eye was referred to us. The vision of his left eye was intact light perception and hand motions. The slit-lamp examination revealed severe inflammation of the anterior chamber with hypopyon, posterior synechiae, and opacity of the posterior lens capsule. Funduscopy showed no red reflex, no retinal details. In the local hospital serum analysis was performed and showed in Western-Blot IgM- and IgG-antibodies against Borrelia burgdorferi. Despite of intravenous application of ceftriaxon for 14 days panuveitis persisted, and endophthalmitis developed when antibiotic therapy was finished. RESULTS: During pars plana vitrectomy a sharply delineated cystic lesion containing yellowish fluid was revealed, and creamy yellow fluid was aspirated. Microscopically in hematoxylineosin stained slides of the aspirate structures consistent with Borrelia burgdorferi were found. Postoperatively vision increased to 1/15. Despite of a second intravenous ceftriaxon treatment for 14 days we observed a retinal vasculitis in the follow up of 6 months. CONCLUSIONS: Despite intravenous ceftriaxon-therapy borrelia burgdorferi must have survived in the vitreous body. Further investigations are required with respect to the use of other antibiotics or immunosuppressives.

PMID: 10048013
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Sun 10 Feb 2008 10:01

Clin Neurophysiol. 2006 Oct;23(5):416-20. Links

Motion-onset and pattern-reversal visual evoked potentials in diagnostics of neuroborreliosis.

Kubová Z, Szanyi J, Langrová J, Kremlácek J, Kuba M, Honegr K.
Department of Pathophysiology, Charles University in Prague, Faculty of Medicine in Hradec Králové, Czech Republic. kubova@lfhk.cuni.cz

Neuroborreliosis is a form of borreliosis that affects the central and/or peripheral nervous system. Although it can mimic neurologic and ophthalmologic disorders such as multiple sclerosis and optic neuritis, visual evoked potential (VEP) examination is usually not used in neuroborreliosis diagnostics. Combined VEP testing (pattern-reversal VEPs and VEPs produced in response to linear and radial motion) was performed in 81 patients with neuroborreliosis verified by laboratory results (positive polymerase chain reaction or intrathecal antibodies production). Thirty-four patients reported diplopia or blurred vision related to borreliosis. In 33 (40%) patients the VEPs were delayed: motion-onset VEPs were pathologic in 22 (27%) patients, reversal VEPs in 5 (6%) patients, and both VEP types in 6 (7%) patients. The findings suggest that VEP testing (especially the motion-onset VEP testing) can confirm CNS involvement. Much higher sensitivity of motion-onset VEPs in comparison with reversal VEPs can result from rather selective (earlier) involvement of the magnocellular system or the dorsal stream of the visual pathway.

PMID: 17016151
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Mon 11 Feb 2008 20:23

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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