Lyme disease, caused by the bacterium Borrelia burgdorferi and transmitted through the bite of infected Ixodes ticks, is known for affecting the joints, heart, and nervous system. This infection can also impact vision, as the bacteria can travel through the bloodstream and reach the eye. Ocular involvement, while less frequent than neurological or arthritic issues, can occur at any stage of the disease. It causes a range of inflammatory conditions that require swift medical attention to preserve vision.
How Lyme Disease Affects Specific Ocular Structures
The infectious spirochete, Borrelia burgdorferi, or the resulting inflammatory response, can affect nearly every structure of the eye. A common inflammatory condition is uveitis, which involves the uvea, the middle layer of the eye. Uveitis can manifest as anterior, intermediate, posterior, or panuveitis, with intermediate uveitis—affecting the vitreous and peripheral retina—being a frequent presentation. In the posterior segment, the infection can trigger retinal vasculitis, which is the inflammation of the blood vessels supplying the retina.
The optic nerve, which transmits visual information from the eye to the brain, is also susceptible to damage, leading to optic neuritis. This neuro-ophthalmic manifestation often involves swelling of the optic disc at the back of the eye, resulting from the systemic neurological effects of the disease. In the earliest stage of infection, a mild, non-specific follicular conjunctivitis—an inflammation of the clear membrane covering the white of the eye—may occur. This early inflammation is typically self-limited and affects about ten percent of patients with early Lyme disease.
Recognizing Visual Symptoms of Ocular Lyme
When deeper structures of the eye become inflamed, patients experience significant visual disturbance. Blurred or decreased central vision is a common symptom, particularly when the uvea or the optic nerve is involved. Inflammation inside the eye can also cause an increase in floaters, which appear as specks or clouds moving across the field of vision.
Patients frequently report significant eye pain and photophobia, or extreme sensitivity to light, which are hallmarks of intraocular inflammation like uveitis. Early involvement of the conjunctiva may present as eye redness and irritation, often resembling typical pink eye. Pain with eye movement or sudden, noticeable vision loss can signal the more serious complication of optic neuritis, requiring immediate attention.
Diagnosis and Treatment for Eye Involvement
Diagnosing ocular Lyme disease is challenging because visual symptoms mimic many other inflammatory and infectious conditions. The diagnostic process begins with a detailed eye examination, including a slit-lamp evaluation, and a thorough patient history regarding tick exposure. Confirmation of systemic Lyme infection uses a two-step serological protocol: an Enzyme-Linked Immunosorbent Assay (ELISA) followed by a Western Blot test.
Ocular manifestations often appear in the disseminated or late stages of the disease, complicating the connection between the eye condition and the original infection. Effective treatment depends on the specific structure affected and the severity of the inflammation. Systemic antibiotic therapy is the mainstay of treatment to eradicate the Borrelia bacteria. Oral antibiotics are sufficient for milder, early-stage manifestations like conjunctivitis or mild keratitis.
For severe intraocular inflammation, such as uveitis, or for neuro-ophthalmic issues like optic neuritis, intravenous (IV) antibiotics are often required. Alongside antibiotics, adjunctive therapies like topical or systemic corticosteroids are frequently used to manage severe inflammation. This combined approach controls tissue damage caused by the immune response while the antibiotics target the underlying infection. Prompt identification and treatment are crucial, as aggressive management typically leads to a good prognosis for visual recovery, while delayed treatment risks permanent vision loss.