Ocular Signs of Lyme Disease

Lyme disease is a tick-borne disease that can cause symptoms in many body systems, including the eyes, well after the initial tick bite occurs. Ocular problems are uncommon side effects of Lyme disease that can occur in the early or late phase of the disease and can take many different forms. Treating Lyme disease with antibiotics along with treating specific eye complications is essential to prevent recurrent eye problems.

The castor bean tick (Ixodus ricinus). (Image: ErikKarits/iStock/Getty Images)

Conjunctivitis

Conjunctivitis, or redness and discharge due to inflammation of the conjunctiva, can occur in the early phase of Lyme disease. The conjunctiva, or lining of the eyeball and lower eyelid, looks pinkish, with tiny reddened blood vessels visible. Pus may be present, according to the Illinois Eye and Ear Infirmary. This type of conjuncitvitis is not contagious and clears up on its own.

Uveitis

An inflammation of the uvea, the middle part of the eye, is called uveitis. The uvea is made up of the iris, the colored part of the eye; the ciliary body, which makes the fluid that fills the eye; and the choroid, the layer beneath the retina. According to Allen Ho, M.D., Lyme disease can cause intermediate uveitis, also known as pars planitis, which affects the area behind the iris. According to the Merck Manual, pars planitis is often painless; the main symptoms are increased floaters--dark dots or lines that move around--and vision loss. The main treatment used for uveitis is steroid eye drops, which reduce inflammation. Treatment can take several months, because steroids need to be slowly reduced or a rebound effects will occur. Drops that dilate the pupil may be used to keep the iris from sticking to the lens, which can happen if the iris becomes scarred, according to Dr. Ho. This can cause permanent vision loss.

Optic Neuritis

The optic nerve carries impulses from the retina to the brain. Optic neuritis is an inflammation of the fibers that cover the optic nerve. According to the Mayo Clinic, Lyme disease can cause optic neuritis. Symptoms of the disease are pain in the eye, inability to see color and vision loss.Steroids are given both intravenously and as eye drops to treat optic nerve neuritis, according to the Mayo Clinic.

Keratitis

Keratitis, or inflammation of the cornea, can be a sign of Lyme disease, according to the Merck Manual. Keratitis may cause pain in the eye, light sensitivity, tearing and blurred vision. The eye may appear opacified, or covered with a white haze. Prednisone, a steroid, is given as eye drops, or by mouth for two to six months in deeper infections.

Retinal Vasculitis

Inflammation of the blood vessels of the retina, also known as retinal vascultis, can occur as a complication of Lyme disease, according to K. Durrani, M.D. The most common symptoms of retinal vasculitis are painless, gradual vision loss. According to Durrani, treatment depends on the presentation of the disease but usually includes high-dose steroids and may include ocular injection of steroids. Laser may be used if many small hemorrhages occur in the eye.

Branch Retinal Vein Occlusion

Lyme disease is occasionally associated with Branch Retinal Vein Occlusion (BRVO), a blockage in the veins of the retina. BRVO can cause vision loss in the area where the blockage is located, according to VitreoRetinal Surgery. There's no pain associated with a BRVO, but vision loss occurs if the blockage causes swelling in the macula. Treatment is laser if the blockage is away from the macula, or intravitreal injection of steroids if swelling occurs in the macula.

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