Ocular Manifestations Of Lyme Disease Research Articles

Ocular Manifestation of Lyme Disease: A Rare Case of Branch Retinal Vein Occlusion

A 63-year-old male from Northeastern Pennsylvania presented in fall with the complaint of sudden onset of blurred vision in the right eye. This was preceded by a history of Lyme arthritis diagnosed with positive immunoglobulin titers (IgG and IgM) on Western blot analyses of the synovial fluid four weeks ago. His past medical history was remarkable for hypertension and hyperlipidemia. The sudden decrease in right eye visual acuity was moderate and reported at all distances.

Isolated bilateral optic neuritis revealing a Lyme Disease : case report

Optic neuritis (ON) is an inflammation of the optic nerve and one of the most common manifestations of central nervous system involvement caused by various etiologies. Lyme optic neuritis is a rare ocular manifestation of Lyme Disease. We report a case of a 13-year-old male patient, previously healthy, with decreased central visual acuity on his both eyes . On examination, best-corrected visual acuity on both eyes was 0,3 LogMar. Anterior segment biomicroscopy showed no inflammatory signs and the intraocular pressure was normal. A fundus examination performed under mydriasis revealed a swollen optic disk on both eyes confirmed by fluorescein angiography. The cerebrospinal fluid examination and Lyme Disease blood findings were positive. The diagnosis of Lyme disease-related optic neuritis was made. Treated with Ceftriaxone and Doxicycline, there was a vision recovery. We can state that isolated bilateral optic neuritis is uncommon and exceptional especially in children during Lyme disease.

Simultaneous involvement of optic and abducens nerves by Lyme disease: Case report with review of the literature.

Ocular manifestations of Lyme disease (LD) remain a rare feature of the disease, but it may present a wide range of clinical presentations with different combinations. LD related optic neuritis or cranial nerve (CN) six palsy have been reported in the literature. However, this is the first case report of simultaneous involvement of CN 2 and CN 6 in a patient with LD. The diagnosis of LD can be challenging and initial laboratory tests can be a false negative. It is paramount important to repeat the diagnostic test if clinical suspicious is ongoing. With this case, we aim to increase awareness of clinicians for possible ocular manifestations of LD and its complex diagnostic process.

Unusual Presentation of Unilateral Isolated Probable Lyme Optic Neuritis.

Optic neuritis (ON) is one of the most common manifestations of central nervous system involvement caused by various etiologies. Lyme ON is an exceedingly rare ocular manifestation of Lyme disease (LD) and only a few cases have been published in the literature. Lyme ON is very rare but should be included in the differential diagnosis in unexplained cases, particularly in Lyme endemic areas. Careful and detailed examination and investigation are warranted to make the diagnosis. We report this case to increase awareness of clinicians to include Lyme disease in differential diagnosis of ON for unexplained cases of ON. Herein we present a unique case with a unilateral ON caused by LD along with pre- and posttreatment findings and literature review.

Lyme disease: resolution of a serous retinal detachment and chorioretinal folds after antibiotic therapy.

Ocular manifestations of Lyme disease are uncommon. There has not been a documented case of serous retinal detachment and chorioretinal folds because of Lyme disease that have resolved after only antibiotic treatment. A 69-year-old white man with a history of recent tick bites presented with a gradual decrease in visual acuity in the left eye. Initial visual acuity was 3/200 in the left eye. Examination revealed an inferior, serous, macula-off retinal detachment. Chorioretinal folds were also noted. Lyme screening antibody test (enzyme-linked immunosorbent assay) was positive and a confirmatory Western blot was immunoglobulin M negative and immunoglobulin G positive. Oral amoxicillin (500 mg 3 times daily for 2 weeks) was given followed by intravenous ceftriaxone (2 g daily for 4 weeks). After two weeks of ceftriaxone, fundus examination and ultrasonography showed complete reattachment of the macula and periphery, and only mild residual chorioretinal folds remained on fluorescein angiogram. We suggest that Borrelia burgdorferi infection led to choroidal inflammation with secondary chorioretinal folds and a serous retinal detachment, which resolved with antibiotic therapy alone. This supports the suspicion of an intraocular infection, perhaps involving the choroid, as opposed to a secondary autoimmune reaction.

Ocular zoonoses

Ocular zoonoses are relatively uncommon causes of ocular inflammation. Among the 175 well-described zoonotic diseases, approximately 30 are known to cause human ocular infections. In this article, we review the most prevalent ocular zoonoses indigenous to North America or Europe. The infections cause toxoplasmosis, toxocariasis, Lyme disease, cat-scratch disease and leptospirosis. Diagnoses of toxoplasma posterior uveitis and ocular toxocariasis are principally based on ophthalmologic findings. Laboratory tests, including antibody titers in ocular fluids, help to support diagnosis when ocular manifestations are atypical. A new trend in toxoplasmosis treatment is to replace sulfadiazine with azithromycin. Trimethoprim/sulfamethoxazole (cotrimoxazole) has proven efficacy in reducing recurrences of toxoplasmic retinochoroiditis. Ocular manifestations of Lyme disease are protean, but the most common are intermediate uveitis and retinal vasculitis. Parinaud oculoglandular syndrome and neuroretinitis with macular stellate exudates are highly suggestive of Bartonella henselae infection (bartonellosis). Diagnoses of the ocular manifestations of leptospirosis and Lyme disease are mainly based on positive histories of animal exposure, nonophthalmologic findings and laboratory investigations. Nongranulomatous uveitis, hypopion, vitritis, membranous veil-like opacities, disk edema and retinal periphlebitis are characteristic features of leptospirosis uveitis. Recent studies showed that PCR tests for bacteria in ocular specimens help in diagnosis (e.g., of infectious uveitis).

Neuro-ophthalmic Manifestations of Lyme Disease

Lyme disease is a multisystem disorder caused by infection with the Borrelia burgdorferi spirochete. The diagnosis of Lyme disease usually is based on several clinical criteria, with supportive data from laboratory testing. The presence of the bullseye skin lesion, erythema migrans, is the single pathognomonic criterion. In the 20 years since the initial description of Lyme disease in the United States, B. burgdorferi has been implicated as an etiologic agent in numerous ophthalmic and neuro-ophthalmic syndromes, involving most structures from the cornea to the cranial nerves. Neuro-ophthalmic and ocular manifestations of Lyme disease include meningitis with papilledema, cranial neuropathies, follicular conjunctivitis, nummular keratitis, and intraocular inflammation. Although an association with Lyme disease has been purported for numerous other syndromes, a definite causal relationship has not been proved in many cases. During a period of rapidly increasing awareness of Lyme disease, a high index of suspicion and poorly defined criteria for its presence have resulted in over-diagnosis of Lyme disease. In the authors' experience, the incorrect diagnosis of Lyme disease initially has been made in patients with allergic conjunctivitis, keratoconus, morning glory syndrome, craniopharyngioma, meningioma, CNS lymphoma, paraneoplastic syndrome, multiple sclerosis, sarcoid, syphilis, and functional illness. Nevertheless, this treatable infection must be an important consideration in the differential diagnosis of certain ocular or neurologic diseases.

The ocular manifestations of Lyme disease.

LD (with its ocular manifestations) is a worldwide disorder that is increasing in frequency. It is a treatable multisystemic disease that presents in three stages of severity. It can present with unusual forms of conjunctivitis, keratitis, cranial nerve palsies, optic nerve disease, uveitis, vitreitis, and other forms of posterior segment inflammatory disease. A patient with any of these ocular manifestations should be questioned for exposure to an area endemic for LD, tick bites, skin rash, or arthritis. Such patients should undergo serological testing. If the clinical presentation is suggestive of LD, a course of oral antibiotics should be used (unless the patient gives a history of adequate therapy). Topical corticosteroids can be used for anterior segment inflammation. An antibiotic therapeutic trial can be used for posterior segment or neuroophthalmic disease. Systemic corticosteroids without concomitant antibiotics should not be used in the treatment of ocular LD. If ocular LD is discovered and treated early, response to therapy usually is satisfactory.

Ocular manifestations of Lyme disease

Although ocular manifestations of Lyme disease have long been noted, they remain a rare feature of the disease. The spirochete invades the eye early and remains dormant, accounting for both early and late ocular manifestations. A nonspecific follicular conjunctivitis occurs in approximately 10% of patients with early Lyme disease. Keratitis occurs often within a few months of onset of disease and is characterized by nummular nonstaining opacities. Inflammatory syndromes, such as vitritis and uveitis, have been reported; in some cases, a vitreous tap is required for diagnosis. Neuro-ophthalmic manifestations include neuroretinitis, involvement of multiple cranial nerves, optic atrophy, and disc edema. Seventh nerve paresis can lead to neurotrophic keratitis. In endemic areas, Lyme disease may be responsible for approximately 25% of new-onset Bell's palsy. Criteria for establishing that eye findings can be attributed to Lyme disease include the lack of evidence of other disease, other clinical findings consistent with Lyme disease, occurrence in patients living in an endemic area, positive serology, and, in most cases, response to treatment. Management of ocular manifestations often requires intravenous therapy.

The Ocular Manifestations of Lyme Disease

Lyme disease (with its ocular manifestations) is a worldwide disorder that is rapidly increasing in frequency. It is a treatable, multisystemic disease that presents in three stages of severity. It can present with unusual forms of conjunctivitis, keratitis, cranial nerve palsies, optic nerve disease, uveitis, vitritis, and other forms of posterior segment inflammatory disease. A patient with any of these ocular manifestations should be questioned for exposure to an area endemic for Lyme disease, tick bites, skin rash, or arthritis. Such patients should undergo serological testing. If the clinical presentation is suggestive of Lyme disease, a course of oral antibiotics should be used (unless the patient gives a history of adequate therapy). Topical corticosteroids can be used for anterior segment inflammation. An antibiotic therapeutic trial can be used for posterior segment or neuroophthalmic disease. Systemic corticosteroids without concomitant antibiotics should not be used in the treatment of ocular Lyme disease. If ocular Lyme disease is discovered and treated early, response to therapy is usually satisfactory.

Branch Retinal Artery Occlusion Associated With Lyme Disease

Lyme borreliosis is a tick-borne spirochetal illness that may involve numerous organs. Multiple ocular manifestations of Lyme disease have been reported, including anterior uveitis, vitritis, episcleritis, conjunctivitis, keratitis, choroiditis, and exudative retinal detachment. 1 Several neuro-ophthalmologic complications have also been recognized. 1 We recently treated a patient with a branch retinal artery occlusion and positive results of serologic tests to detect Lyme disease who responded well to antibiotic therapy. To our knowledge, this is a new ocular manifestation of Lyme disease. Report of a Case. —A 37-year-old white woman awoke with a scotoma above fixation in her left eye. For the previous several months, she had generalized arthralgias and fatigue. Two months before presentation, she developed floaters in both eyes as well as daily, throbbing headaches. She was not pregnant and took no medications or birth control pills. There was no known history of a tick bite or skin rash.

Episcleritis, Conjunctivitis, and Keratitis as Ocular Manifestations of Lyme Disease

A 35-year-old woman presented with a bilateral palpebral follicular conjunctivitis. Subsequently, she developed a bilateral keratitis and, on a separate occasion, an episcleritis that was associated with a recrudescence of Lyme disease and poor compliance with the antibiotic regimen. Both the keratitis and episcleritis cleared completely after topical corticosteroid therapy and reinstitution of appropriate antibiotic treatment. This report emphasizes the importance of collaboration between internal medicine and ophthalmologic specialists during the long-term management of Lyme disease.

Ocular Lyme disease: case report and review of the literature.

Lyme disease is an emerging new spirochaetal disease in which ocular complications may arise. We have seen a 45-year-old woman who developed unilateral endophthalmitis leading to blindness during the course of this disease. Ocular tissue showed the characteristic spirochete. A literature review shows that the commonest ocular manifestation of Lyme disease is a mild conjunctivitis, but other symptoms may include periorbital oedema, oculomotor palsies, uveitis, papilloedema, papillitis, interstitial keratitis, and others. Ophthalmologists treating patients from Lyme disease endemic areas need to be aware of the protean clinical manifestation of this disease.