Revenge of the Tick: Tick-Borne Diseases and the Eye in the Age of Climate Change and Globalisation

Abstract

Climate change has contributed to changes in disease transmission. In particular, zoonoses such as tick-borne diseases are occurring in areas previously unsuitable for tick survival, with spread to non-endemic areas rising. Ophthalmic manifestations of tick-borne diseases are rare. Often overlooked, diagnosis requires awareness and a high level of suspicion, which may delay treatment. This review provides a comprehensive overview of ocular disease associated with ticks so that management protocols for patients can be designed and implemented. A narrative literature review was conducted. The current literature includes case series, case reports, and literature reviews. Ocular manifestations of tick-borne diseases include adnexal manifestations, conjunctivitis, keratitis, cranial nerve palsies, optic nerve disease, uveitis, exudative retinal detachment, and panophthalmitis, which may occur in isolation or as part of a systemic process. As there is no one constellation of ocular symptoms and signs diagnostic of tick-borne eye diseases, a systematic approach is recommended with particular attention to significant travel and exposure history. In this review, we identify significant risk factors and propose management strategies for afflicted patients to improve treatment outcomes while maintaining cost-effectiveness. Ophthalmologists and generalists will benefit from increased awareness of ocular manifestations of tick-borne diseases in the age of modern travel and climate change.