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 12 Feb 2008 11:13

Ger J Ophthalmol. 1996 Jan;5(1):12-5. Links

Neuroborreliosis with retinal pigment epithelium detachments.

Koch F, Augustin AJ, Böker .
University Eye Hospital Bonn, Germany.

Borreliosis or Lyme disease, a tick-borne infection with the spirochete Borrelia burgdorferi, can cause various ocular and neurological symptoms. A 41-year-old man had been repeatedly bitten by ticks in June 1992; 6 months later, the patient complained of blurred vision in both eyes of 1-week duration, bifrontal headache that was more pronounced on the right side, and neck pain that had appeared months earlier and was becoming more severe. On ophthalmoscopy, clover-shaped retinal pigment epithelium detachments around the optic disc were observed in both eyes. The patient's visual acuity was reduced to 0.5 in his left eye. Liquor cells and total protein were significantly increased; however, a hemagglutination inhibition test revealed only moderately increased immunoglobulin values. After 2 weeks of daily application of 4 g ceftriaxone disodium, ophthalmological and neurological symptoms disappeared. Even though the immunoglobulin values remained unchanged, neuroborreliosis with involvement of the retinal pigment epithelium was the most probable diagnosis, considering the history of tick bites and headache. The authors assume that the tissue around the optic nerve head, which does not have an effective blood-brain barrier, allowed the spirochetes to spread from the central nervous system into the subpigment-epithelium space, thus causing the observed parapapillary pigment epithelium detachments.

PMID: 8646173
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Mon 25 Feb 2008 20:49

Borrelia-associated crystalline keratopathy

Text

Objective
Crystalline keratopathy can be associated with paraproteinaemia or with infection by micro-organisms. We present a patient with crystalline keratopathy with proof of borellia in the corneal stroma.

Methods
Case report of asymmetric bilateral progressive peripheral crystalline keratopathy in a 67-year-old male patient with a history of recurrent iridocyclitis and polyarthritis under immunosuppression. After a paraproteinaemia had been excluded and due to a progressive visual loss to 0.1 in the right eye, we performed a triple procedure. During the postoperative follow-up, deep stromal crystalline deposits recurred, starting in the periphery. After six months, the graft became diffusely cloudy. One year after keratoplasty, the patient presented with a hyperacute stromal graft rejection, and we performed re-keratoplasty à chaud.

Results
By light- and electronmicroscopy we detected spirochaetes in the corneal specimen. By means of PCR proof of bacterial nucleic acid (16S-rDNA) was feasible. The result of amplification could be assigned to the species Borrelia burgdorferi by sequence analysis. Three months after re-keratoplasty, the patient presented with a clear graft under systemic and local antibiotics, local steroids and systemic immunosuppression.

Conclusions
In bilateral peripherally accentuated ring-shaped crystalline keratopathy resistent to conventional therapy a borrelia-associated interstitial keratitis should be ruled out. Diagnosis could be verified by incisional biopsy. Antibiotic treatment with cephalosporines or tetracyclines may prevent a progression or recurrence after keratoplasty.

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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Sun 20 Apr 2008 11:23

Retina. 1994;14(1):39-42. Links

Cytologically proven seronegative Lyme choroiditis and vitritis.

Schubert HD, Greenebaum E, Neu HC.
Edward S. Harkness Eye Institute, New York, New York.

PURPOSE: To report on a vitreous specimen in a 53-year-old patient with unilateral choroiditis and vitritis of unknown cause. METHODS: Cytologic examination of a vitreous aspirate stained by the Papanicolaou method. RESULTS: Intravitreal spirochetes consistent with Borrelia burgdorferi were found in this seronegative patient. CONCLUSION: Vitreous specimens of patients with choroiditis and vitritis of unknown cause should be examined cytologically, particularly when serologic results do not corroborate the clinical findings of Lyme disease.

PMID: 8016460
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Fri 25 Apr 2008 16:16

1: Cornea. 2008 May;27(4):498-500.

Borrelia-associated Crystalline Keratopathy With Intracorneal Detection of Borrelia garinii by Electron Microscopy and Polymerase Chain Reaction.

Dietrich T, Geidörfer W, Schlötzer-Schrehardt U, Holbach L, Schoerner C, Seitz B.
From the *Department of Ophthalmology and †Department of Microbiology, Immunology and Hygiene, University Erlangen-Nürnberg, Erlangen, Germany; and the ‡Department of Ophthalmology, Saarland University Hospital, Homburg/Saar, Germany.

PURPOSE:: First report of a patient with Borrelia-associated crystalline keratopathy with intracorneal evidence of Borrelia garinii by polymerase chain reaction (PCR) and electron microscopy (EM). METHODS:: Report of a 67-year-old patient with medical history of recurrent iridocyclitis and arthritis presented with a bilateral, progressive, asymmetric crystalline keratopathy, which was particularly pronounced in the peripheral temporal superior cornea. After penetrating keratoplasty, crystalline keratopathy with stromal haziness recurred. Corneal regrafting was performed. The corneal specimen from the penetrating keratoplasty was examined by light and EM as well as by PCR. RESULTS:: In the explanted corneal graft, as well as retrospectively in the corneal specimen from the first keratoplasty, spirochetelike bodies and fragments were detected by light and EM. Borrelia burgdorferi sensu lato DNA was demonstrated by broad-range (16S rDNA) PCR. A more precise identification as Borrelia garinii serotype 5 was possible by analyses of the flaB and ospA gene sequences. Borrelia-specific serological tests showed borderline titers in immunofluorescence and weak reaction in immunoblot, respectively. CONCLUSIONS:: This case illustrates that borreliae must be considered as a cause of crystalline keratopathy; Borrelia-specific serological tests can be false negative; explanted cornea specimens of etiologically unclear crystalline keratopathy should be analyzed by EM or PCR for detection of pathogens; and prolonged antibiotic treatment might be effective to prevent progression or recurrence of the disease.

PMID: 18434857
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Thu 1 May 2008 10:58

: Coll Antropol. 2005;29 Suppl 1:137-9.Links

Paralytic strabismus as a manifestation of lyme borreliosis.

Zrinsćak O, Masnec-Paskvalin S, Corak M, Baćani B, Mandić Z.
University Department of Ophthalmology, Clinical Hospital, Systers of Mercy, Zagreb, Croatia. ozrinscak@yahoo.co.uk

Lyme disease is a multi-system organ disorder caused by Borrelia burgdorferi. Although ocular manifestations have been reported, these remain a rare feature of the disease. This report shows a 49-years old patient that has been bitten by a tick and as consequence of which developed symptoms of the Lyme disease. In 1998 the patient was hospitalized in our Eye Clinic due to operating treatment of the paralytic strabismus (abductal nerve paralysis), as a rare feature of the Lyme disease. Postoperative squint angle was significantly reduced, but without any temporal movement. Diplopia was still present, though slightly reduced with the use of prism eyeglasses. The improvement of the quality of life was achieved, as well as the patient's satisfaction.

PMID: 16193697
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cave76
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Re: Lyme Disease and the eyes

Post by cave76 » Thu 1 May 2008 16:26

Yvonne,

This isn't at ALL a comment about your above post. :)

It just brought to my mind all the studies that say "this or that is a 'rare' occurrence in Lyme'

HOW IN THE BLUE BLAZES DO THEY KNOW?????

So, an ophthalmologist who just might, just maybe, look a tiny bit out of the box, might, maybe come across that abstract and think:

"Could this possibly be Patient X's problems"

"Nah. It's rare and the chances are---- not."

"Look for horses not zebras" (What all doc's are taught!)

If something isn't looked for how do they KNOW?

Answer: THEY DON'T

There! That felt good! :)

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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Sat 31 May 2008 22:39

1: Jpn J Infect Dis. 2008 May;61(3):214-5. Links

Molecular Diagnosis of a Bilateral Panuveitis due to Borrelia burgdorferi Sensu Lato by Cerebral Spinal Fluid

Analysis.Wallet F, Labalette P, Herwegh S, Loiez C, Margaron F, Courcol RJ.
Pole de Microbiologie, Laboratoire de Bacteriologie-Hygiene, Lille Cedex, France. fwallet@chru-lille.fr.

The present paper describes a case of bilateral panuveitis due to Borrelia burgdorferi sensu lato diagnosed by a PCR approach using cerebral spinal fluid. Since the culture of B. burgdorferi takes a long time to grow and the accuracy of serological tests is doubtful in patients, the PCR method of amplifying a B. burgdorferi flagellin could be suitable to make a positive diagnosis in a case of atypical clinical history of Lyme disease.

PMID: 18503173
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Yvonne
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Re: Lyme Disease and the eyes

Post by Yvonne » Thu 17 Jul 2008 21:18

Acta Ophthalmol. 2008 May 27. [Epub ahead of print] Links

Inflammatory choroidal neovascular membrane in presumed ocular Lyme borreliosis.

Amer R, Brannan S, Forrester JV.
Department of Ophthalmology, Aberdeen Royal Infirmary, UK.


Introduction: Lyme disease is a multisystemic disease with protean ocular manifestations. We describe the occurrence of inflammatory choroidal neovascular membrane (CNVM) in two patients suffering from presumed Lyme disease. Methods: Descriptive review of the clinical records of two patients. Results: Patient 1: 16-year-old healthy male presenting with a visual acuity of counting fingers [oculus dexter (OD)] and 6/6 [oculus sinister (OS)] 3 months after a tick bite. He had papillitis and an exudative subretinal macular lesion OD. Treatment was started with intravenous (IV) ceftriaxone; a week later, IV methylprednisolone was administered with a tapering dose of oral steroids thereafter. Three months later, VA had improved to 3/60 OD. Patient 2: 38-year-old healthy female presenting with reduced left-eye vision (6/24) 6 weeks after a tick bite. She also suffered from erythema migrans and arthralgias. She had left-eye papillitis, macular haemorrhages and vascular sheathing. Treatment was started with IV ceftriaxone. One month later, there was profound loss of vision with development of CNVM. Treatment was declined by the patient and eventually retinal fibrosis developed. Conclusion: Inflammatory CNVM has not been described previously in the setting of ocular Lyme borreliosis. We herein describe the occurrence of inflammatory CNVM in two patients whose diagnosis with Lyme disease was clinically based - both were sero-negative. Visual outcome in the two patients was profoundly impaired because of the ensuing macular scar.

PMID: 18507732
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breezywings
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Re: Lyme Disease and the eyes

Post by breezywings » Sat 2 Aug 2008 17:36

I was scrolling through some posts here and find this group so incredibly informational.

I soooo needed this information as I am having some struggles with my eyes that my eye guy think are related.

We shall see.

I will run off this info and give it to him.

He looks for zebra's. :D

Boomerang
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Re: Lyme Disease and the eyes

Post by Boomerang » Tue 5 Aug 2008 2:07

Hope you find out something from the doc, breeze!

Interesting thing....hubby was complaining of blurry vision again yesterday. This has happened periodically. I always assume it is related to die off. ??

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