Lyme disease, a serious illness transmitted to humans by infected blacklegged ticks, leads to a variety of symptoms for patients. The CDC reports that common symptoms may include fatigue, headache, fever, and a characteristic erythema migrans rash. However, patients who have contracted Lyme disease may also experience some ocular symptoms.

Different ocular symptoms are present during each stage of Lyme disease. During the first stage of untreated Lyme disease, which can occur up to 30 days after the infected tick bite, the patient may experience a mild case of conjunctivitis and/or photophobia. The second stage of Lyme disease brings about more serious ocular symptoms, including optic neuritis and Bell’s palsy. The final stage of the disease displays the most serious ocular symptoms, which may include pars planitis, branch artery occlusion, retinal vasculitis, optic neuritis, uveitis, and keratitis. These symptoms, outlined by stage, include:

Conjunctivitis

Conjunctivitis occurs when the lining of the eyelids becomes red and inflamed. In some cases, a discharge of pus may also be present.


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Photophobia

Patients suffering from early-stage Lyme disease may also experience photophobia, which manifests as pain and discomfort when the eye is exposed to light.

Optic Neuritis

As Lyme disease progresses, it often causes damage and swelling within the optic nerve. This can lead to blurred vision in one or both eyes.

Bell’s Palsy

Bell’s palsy occurs when a cranial nerve becomes dysfunctional and causes facial paralysis. Although Bell’s palsy is not an ocular condition on its own, it can lead to other ocular symptoms, such as dry eyes, damage, and infection.

Pars Planitis

Pars planitis occurs when the area behind the iris becomes inflamed. Although the condition is not painful, it can eventually lead to vision loss. Other symptoms include an increase in the frequency of floaters.

Branch Artery Occlusion

Late-stage Lyme disease can lead to branch artery occlusion, which refers to a blockage in the arteries connected to the eye. As they worsen, these blockages can cause swelling and vision loss in the surrounding area.

Retinal Vasculitis

Another symptom of late-stage untreated Lyme disease is retinal vasculitis, which occurs when the blood vessels of the retina become inflamed. According to the American Uveitis Society, retinal vasculitis can occur as a direct symptom of Lyme disease, or it may present secondary to pars planitis. Patients with retinal vasculitis experience blurred vision, blind spots, floaters, distorted vision, and altered perception of colors.

Keratitis

Lyme disease can sometimes cause keratitis, the inflammation of the cornea. Symptoms of keratitis may include pain in the eye, redness, blurred vision, vision loss, and an increase in discharge or tears from the affected eye.

Reference

  1. Gordon LK. Retinal vasculitis. American Uveitis Society website. January 2003. http://www.uveitissociety.org/pages/diseases/retinalvasculitis.htm.
  2. Lyme disease. Centers for Disease Control and Prevention website. Updated June 23, 2014. http://www.cdc.gov/lyme/.
  3. Lyme disease and the eye. University of Illinois College of Medicine at Chicago website. http://chicago.medicine.uic.edu/cms/One.aspx?pageId=15654493.
  4. Robin S. Ocular signs of Lyme disease. Livestrong website. http://www.livestrong.com/article/71899-ocular-signs-lyme-disease/.