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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Re: Lyme Disease and the eyes

Post by RitaA » Tue 15 Oct 2013 3:52
Case Rep Infect Dis. 2011;2011:372470. doi: 10.1155/2011/372470. Epub 2011 Jul 28.

Two cases of orbital myositis as a rare feature of lyme borreliosis.

Sauer A, Speeg-Schatz C, Hansmann Y.


Service d'Ophtalmologie, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, BP 426, 67091 Strasbourg Cedex, France.


Myositis has been reported as a rare manifestation of Lyme disease, and the Lyme disease spirochetes can be an important consideration in the differential diagnosis of unusual cases of myositis, especially in patients who live in or travel to endemic areas. We report the case of two patients who presented with focal orbital myositis which are rare localization for Lyme disease. Myositis were confirmed by magnetic resonance imaging. Diagnosis criteria for Borrelia burgdorferi (B. burgdorferi) infection was supported by (i) medical history (tick bite in an endemic area), (ii) systemic clinical findings (Erythema migrans, neurological manifestation or arthritis), (iii) positive Lyme serology and/or the detection of B. burgdorferi DNA by polymerase chain reaction, as well as (iv) exclusion of other infectious and inflammatory causes. The current cases are reviewed in the context of findings from previous myositis descriptions.

PMID: 22567470 [PubMed] PMCID: PMC3336248 Free PMC Article
The full article is here:

3. Discussion


Orbital myositis is an unusual manifestation of Lyme disease, although it is likely that the condition is underdiagnosed. Unexplained muscle swelling occurring in a patient who has had a rash or a recent history of a tick bite in an endemic area for Lyme disease should prompt consideration of this diagnosis. The diagnosis can usually be made on the basis of clinical features and serologic studies. MRI may be a useful adjunct for diagnosis and followup.

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Re: Lyme Disease and the eyes

Post by RitaA » Tue 15 Oct 2013 4:11

I hesitate to post this because it is undated and the list of references does not appear in this pdf document. On the other hand, the summary of ocular manifestations by stage might be useful information for some folks:

Lijing Yao, MD

Lyme disease is a disorder associated with multi-system abnormalities whose most prominent
manifestations affect skin, nervous system, musculoskeletal system and heart. A wide spectrum
of eye involvement has also been reported.
The disease has three defined clinical
stages.1,3,16,17 However, some patients may not present all stages.

Stage I begins within 1 month of an infected tick bite, usually in the summer, and is manifested by
an oval or annular skin rash of varying severity, often with a clear center at the area of the bite:
erythema migrans (Picture 1).17-19 The lesion may itch or be painful, but is often asymptomatic.
Only approximately 30% of persons may recall being bitten. Other symptoms including headache,
malaise, fatigue, fever, and arthralgias; lymphadenopathy may also occur at the early stage.
Stage II follows several weeks to months after infection and is characterized by potential
involvement of nervous system and heart. The neurological symptoms may include severe
headache and stiff neck, meningitis, peripheral radiculopathy, and cranial nerve palsies. The
symptoms of headache, nausea, photophobia and vomiting often indicate meningeal

Cranial nerve palsy may be unilateral or bilateral, and most often affecting the
facial nerves (Bell's palsy).21 Both sensory and motor radiculopathy can occur. Cardiac
involvement more commonly presents with atrioventricular block of varying degree.22 Other
conduction system defects, arrythmias, myocarditis and pericarditis can also occur.
Stage III may occur up to 2 years after the initial infection and is characterized by prolonged
episodes of migratory oligoarthritis and chronic neurologic syndromes.17 Neurological features
include ataxia, chronic encephalopathy, seizure, dementia, myelitis, spastic paraparesis, and
psychiatric disturbances. Other symptoms include fatigue, lymphadenopathy, splenomegaly, sore
throat, dry cough, nephritis, hepatitis, or orchitis.17,18
Table 1. Systemic and ocular features of Lyme disease in different stages of the disease

Ocular Manifestations [i.e. I have included only column 3]

Stage 1


Stage 2

Optic neuritis
Optic nerve atrophy
Retinal hemorrhages
Retinal vasculitis
Exudative retinal detachments
Cystoid macular edema
Anterior or Posterior uveitis
Intermediate uveitis

Stage 3

Chronic intraocular- inflammation
Ocular manifestations of Lyme disease may occur at any stage but are more common in the last two stages.17 The most common ocular finding in stage I is conjunctivitis.19

During the second and third stages, ocular involvement includes anterior, intermediate, and posterior uveitis,
endophthalmitis, keratitis (stromal opacities, punctuate superficial keratitis or peripheral ulcerative
keratitis), and conjunctivitis. Neuroophthalmic features can also occur, including involvement of
third, sixth, and seventh cranial nerves (Bell's palsy, most common),21 optic nerve (optic neuritis
and perineuritis, papilledema, ischemic optic neuropathy, optic nerve atrophy). Other possible
ocular involvement includes retinal hemorrhages, exudative retinal detachments, cystoid macular
edema,20 blepharitis, scleritis and episcleritis.17,21

The most commonly reported ocular syndromes in stage II are conjunctivitis and uveitis.21

Bilateral interstitial keratitis has been described as a characteristic feature in the late stage of Lyme diseses.22-26


Lyme disease is a multi-system disorder caused by B. burgdorferi. It is a tick-borne spirochetal
disease and is transmitted to humans by the bite of a tick with symptoms ranging from a rash,
fever, and headache to joint pain. The disease may affect skin, nervous system, musculoskeletal
system and heart. A wide spectrum of eye involvement has been also reported. A self-limiting
conjunctivitis may be associated with early infection. With dissemination of the disease,
intraocular inflammation and neuro-ophthalmic signs may occur.
The disease is primarily based
on careful history, thorough ocular and physical examination, as well as laboratory testing. Early
diagnosis with appropriate antibiotic therapy is curative. Late sequelae involving the skin, joints
and nervous system can occur and be resistant to antibiotic treatment.
Edited to add:

I found a reference to this document on The Ocular Immunology and Uveitis Foundation's website. The document is from January 2000.
Vol. V No. 1 Jan 2000

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Re: Lyme Disease and the eyes

Post by RitaA » Tue 8 Apr 2014 8:21 ... 4/fulltext
The Lancet, Volume 357, Issue 9258, Page 805, 10 March 2001


Holmes-Adie syndrome and Lyme disease

Raphael B Stricker a , Edward E Winger a


Paolo Martinelli (Nov 18, p 1760)1 provides an excellent clinical and historical overview of Holmes-Adie syndrome (tonic pupil and areflexia), more commonly known in the USA as Adie syndrome. Although the syndrome has not been associated with “infection of conventional bacterial or viral origin”, it is occasionally linked to early syphilis, parvovirus B19, and herpes simplex virus infections.2—4 We now report an association with neurological Lyme disease.

In a referral practice of about 140 patients with Lyme disease, we have seen three patients with predominant neurological symptoms who presented with Holmes-Adie syndrome (table). The diagnosis of Lyme disease was based on a history of tickbite, presence of an erythema migrans rash and positive serology for the spirochaete Borrelia burgdorferi. The duration of Lyme disease symptoms ranged from 2—16 years, and each patient developed a unilateral tonic pupil before the diagnosis of Lyme disease was made. All three patients had significant neuropsychiatric and cognitive defects, hyporeflexia, and facial dysaesthesia without anhydrosis. Rapid plasma reagin testing was negative in each case. Two patients had abnormal brain magnetic resonance imaging with white-matter lesions consistent with neurological Lyme disease. A decreased concentration of CD57 lymphocytes characteristic of chronic Lyme disease5 was found in two patients before antibiotic therapy. Of note, Holmes-Adie syndrome persisted in each case despite intravenous antibiotic therapy and partial resolution of other neurological symptoms of Lyme disease.

Neurological Lyme disease has been associated with various cranial nerve, meningeal, and neuropsychiatric abnormalities.5 Based on our clinical observation, it seems that Holmes-Adie syndrome might represent an early and unrecognised manifestation of Lyme disease. We suggest that patients presenting with this unusual neuro-ophthalmological syndrome should be tested for the Lyme disease spirochaete. ... ?id=337040
European Paediatric Ophthalmological Society

Abstract Preview

Adie’s tonic pupil associated with Lyme disease

Datta Nigel1, Saunte Jon Peiter1, Riise Per1, Schmidt Birgitte2, Milea Dan3

1 Ophtalmologial department, Hillerød Hospital, Copenhagen, Denmark, 2 Statens Serum Institute, Copenhagen, Denmark, 3 Ophthalmological department, Glostrup Hospital, Copenhagen, Denmark


Lyme disease, caused by Borrelia burgdorferi (Bb), can cause ophthalmic and neuro-ophthalmological involvement : uveitis, optic neuritis and cranial nerve palsies are the most frequent ocular manifestations. We report a case of pupillary involvement in a patient with neuroborreliosis.

Material and methods.

Retrospective case study of a 4 year-old girl presenting with recently acquired anisocoria of unknown origin.


Clinical examination disclosed a typical left Adie’s tonic pupil, associating light-near dissociation, vermiform iris sphincter movements at slit-lamp illumination and a positive response to diluted pilocarpin. The remainder of the ophthalmic examination was normal, disclosing no sign of intraocular inflammation. An extensive work-up did not find any typical cause of the tonic Adie’s pupil. Since the patient was living in an endemic area of Lyme disease, testing for Bb was performed, 2 weeks after anisocoria was diagnosed. Serum IgG was highly positive (5, normal range < 3), suggesting Bb infection. A cerebral MRI was normal but CSF examination disclosed highly positive IgG antibodies for Bb suggesting neuroborreliosis. Intravenous treatment with ceftriaxone, had no effect on the anisocoria, which remained stable over the next 4 years.


Adie’s tonic pupil is an unusual finding in children. Lyme disease is a possible cause of an Adie’s tonic pupil and we report the fifth reported case in the literature, to our best knowledge. Borrelia burgdorferi testing should be part of the work-up of an Adie’s pupil in children, especially in endemic regions.
Note: Aniscoria means pupils of differing sizes.

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Re: Lyme Disease and the eyes

Post by RitaA » Sat 19 Apr 2014 10:24

Although this is an older article, it belongs in this thread:
Am J Ophthalmol. 1997 Jan;123(1):136-8.

Chiasmal optic neuritis in Lyme disease.

Scott IU1, Silva-Lepe A, Siatkowski RM.

Author information

1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, USA.



To report Lyme disease as the cause of chiasmal optic neuritis in a 10-year-old girl.


The patient underwent ophthalmologic, laboratory, and imaging examinations.


The patient's history and clinical course were consistent with Lyme disease. Laboratory studies disclosed increased serum Lyme immunoglobulin G titer, which improved after antibiotic treatment.


Lyme disease should be considered in the differential diagnosis of chiasmal optic neuritis.

[PubMed - indexed for MEDLINE]

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