"Eye related problems in LD are commonplace and can include conjunctivitis, ocular myalgias, keratitis, episcleritis, optic neuritis, pars planitis, uveitis, iritis, transient or permanent blindness, temporal arteritis, vitritis and periorbital edema (Jacqueline MS; Ibid). Horner's syndrome, ocular myasthenia gravis, and an Argyll-Robertson pupil are also reported. Optic neuritis has been observed to become recurrent or intractable after treatment with steroids. Given the earlier remarks about the detrimental effects of steroids on LD, recidivous optic neuritis may be due to occult LD." http://cassia.org/essay.htm
"In the early stage of the disease, many persons have conjunctivitis. In this condition, commonly called pink eye, the eyes are red and uncomfortable, and there is a discharge of pus. Unlike many forms of conjunctivitis, the type that occurs in lyme disease is not contagious.
In later stages of the disease, inflammation of the eye may develop. Parts of the eye that may be affected include the uvea, the middle layer inside the eye, the cornea, part of the outer coat of the eye; the iris, the colored circle around the pupil, and the choroid, a layer of blood vessels in the eye. Ocular symptoms can include sensitivity to light and floaters (spots in front of the eyes).
Inflammation of the optic nerve (optic neuritis) also can occur, which results in visual loss. Loss of vision can result from inflammation in the brain as well.
Persons who develop Bell’s palsy may be unable to blink or close their eyes. This dries the cornea and can result in an infection or even a hole in the cornea, which can endanger vision if not treated promptly."
Tomasz Chmielewski, Joanna Brydak-Godowska, Beata Fiecek, Urszula Rorot, Elżbieta Sędrowicz, Małgorzata Werenowska, Dorota Kopacz, Agata Hevelke, Magdalena Michniewicz, Dariusz Kęcik, Stanisława Tylewska-Wierzbanowska
(Laboratory of Rickettsiae, Chlamydiae and Spirochetes, National Institute of Public Heath – National Institute of Hygiene, Warsaw, Poland)
Med Sci Monit 2014; 20:927-931
Background: Clinical data have shown that tick-borne diseases caused by Borrelia burgdorferi sensu lato, Bartonella spp., Coxiella burnetii, andRickettsia spp. can affect the central nervous system, including the eye. The aim of this study was to establish a relationship between the incidence of cataract and evidence of bacterial infections transmitted by ticks.
Material and Methods: Fluid with lenticular masses from inside of the eye and blood from 109 patients were tested by PCR and sequencing. Sera from patients and the control group were subjected to serological tests to search specific antibodies to the bacteria.
Results: Microbiological analysis revealed the presence of Bartonella sp. DNA in intraoperative specimens from the eye in 1.8% of patients. Serological studies have shown that infections caused by B. burgdorferi sensu lato and Bartonella sp. were detected in 34.8% and 4.6% of patients with cataract surgery,respectively.
Conclusions: Presence of DNA of yet uncultured and undescribed species of Bartonella in eye liquid indicates past infection with this pathogen. Specific antibodies to B. burgdorferi sensu lato and Bartonella sp. are detected more frequently in patients with cataract compared to the control group. This could indicate a possible role of these organisms in the pathological processes within the eyeball, leading to changes in the lens. Further studies are needed to identify Bartonella species, as well as to recognize the infectious mechanisms involved in cataract development.
Keywords: Bartonella spp, Borrelia burgdorferi sensu lato, Coxiella burnetii, Rickettsia spp, Cataract
Rev Neurol (Paris). 1988;144(12):765-75.
[Multiple neurologic manifestations of Borrelia burgdorferi infection].
[Article in French]
The neurological spectrum of Borrelia burgdorferi infections is still enlarging. We review epidemiological, pathological and serological data of Lyme disease. The course of the disease is divided in three stages: stage 1 during the first month is characterised by erythema chronicum migrans and associated manifestations; stage 2 includes not only the classical European meningoradiculitis but also less specific neurological symptoms: isolated lymphocytic meningitis with an acute or even relapsing course, apparently idiopathic facial palsy, neuritis of other cranial nerves, polyneuritis cranialis, Argyll-Robertson sign, peripheral nerve involvement, acute transverse myelitis, severe encephalitis, myositis.
During stage 3, three to five months or longer after the onset of the disease, chronic arthritis, acrodermatitis chronica atrophicans and various neurological symptoms can be observed: chronic neuropathy with mainly sensory or motor signs, recurrent strokes due to cerebral angiopathy and progressive encephalomyelitis; this third stage the central nervous system involvement is characterised by slowly progressive or fluctuating course during months or years, ataxic or spastic gait disorder, bladder disturbances, cranial nerve dysfunction including optic atrophy and hypoacusia, dysarthria, focal and diffuse encephalopathy.
This chronic central nervous system disease can mimic multiple sclerosis, anorexia nervosa, psychic disorders or subacute presenile dementia. It is often associated with pleiocytosis, abnormal EEG and evoked potentials, sometimes multifocal and mainly periventricular white matter lesions visualised by CT or MRI, and as a rule high antibody titers against Borrelia burgdorferi.
High doses of penicillin can halt the disease, sometimes induce spectacular regression of symptoms or sometimes be inefficient; ceftriaxone could be a more powerful therapy. Similarities between syphilis and Borreliosis are multiple: both of these spirochetes contain plasmids, can be transmitted through the placenta and progress for many years through successive stages, with multiorgan symptoms, including parenchymatous and vascular lesions of the central nervous system. Borrelia burgdorferi is the new great imitator.
PMID: 3070690 [PubMed - indexed for MEDLINE]
J AAPOS. 2013 Aug;17(4):440-2. doi: 10.1016/j.jaapos.2013.04.008.
Phthriasis palpebrarum can resemble tick larva infestation in an eyelid.
The similarities of the larval and nymph stages of the tick and louse (Pthirus pubis) may lead to misdiagnosis in rare cases of infestation of the eyelashes. The most frequent manifestations of tick in the eye are conjunctivitis, uveitis, keratitis, and vasculitis. Tick inoculation of the skin can locally lead to formation of granuloma and abscess. More concerning is the potential systemic sequelae that can result from transmission of zoonoses such as Lyme disease. P. pubis can cause pruritic eyelid margins or unusual blepharoconjunctivitis. We present a case of phthiriasis palpebrarum in a 4-year-old boy.
Copyright © 2013 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.
PMID: 23993722 [PubMed - indexed for MEDLINE]
NOTE- Opsoclonus refers to uncontrolled eye movement. Opsoclonus consists of rapid, involuntary, multivectorial (horizontal and vertical), unpredictable, conjugate fast eye movements without intersaccadic intervals. It is also referred to as saccadomania or reflexive saccade. The movements of opsoclonus may have a very small amplitude, appearing as tiny deviations from primary position.
J Child Neurol. 2013 Mar 1;29(7):952-954. [Epub ahead of print]
Opsoclonus Associated With Salmonellosis in a 6-Week-Old Infant.
A 6-week-old male infant presented with 2 days of fever, emesis, and diarrhea, associated with episodic and chaotic rapid eyemovements, determined to be opsoclonus. An electroencephalogram (EEG) obtained during the events was normal. He was treated empirically for meningitis, and an initial workup for neuroblastoma including urine homovanillic acid and vanillylmandelic acid levels, abdominal ultrasonography, and computed tomography (CT) of the chest, abdomen, and pelvis was negative.
Stool and blood cultures were positive for Salmonella, and antibiotic regimen was adjusted appropriately. Over the next few days, his fever, emesis, and diarrhea subsided, and the opsoclonus resolved by hospital day 6.
He was back to baseline by hospital day 9. Although there have been cases of parainfectious opsoclonus associated with Lyme disease, enterovirus, Streptococcus, and West Nile virus, this represents the first reported pediatric case of opsoclonus associated with salmonellosis. Only 2 such cases in adults have been reported in the literature.
© The Author(s) 2013.
Salmonella; opsoclonus; parainfectious
Cornea. 2013 Feb;32(2):196-8. doi: 10.1097/ICO.0b013e318274d85d.
Unilateral posterior stromal keratitis possibly secondary to Lyme disease.
- 1Krieger Eye Institute, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA. firstname.lastname@example.org
To report a case of Lyme disease presenting as unilateral posterior stromal keratitis in a pediatric patient.
Case report and review of available literature.
A 13-year-old adolescent with unilateral painless blurry vision presented with prominent posterior corneal stromal haze. A positive Borrelia burgdorferi antibody enzyme immunoassay and Western blot analysis (9 of 10 reactive immunoglobulin G bands and 1 of 3 immunoglobulin M bands) confirmed the diagnosis. Treatment with oral antibiotics and topical corticosteroids were necessary for resolution.
Lyme disease may present as a unilateral posterior stromal keratitis, even in a pediatric population. Treatment requires both systemic and topical therapy.
PMID: 23132459 [PubMed - indexed for MEDLINE]
Clin Ophthalmol. 2012;6:1093-7. doi: 10.2147/OPTH.S32601. Epub 2012 Jul 16.
Case report: papillitis as the sole ocular sign in Lyme disease.
- 1Department of Ophthalmology, Raigmore Hospital, Inverness, United Kingdom.
Lyme disease is a spirochetal disease responsible for a multitude of ocular and systemic manifestations, and patients may present to ophthalmologists and general clinicians with a wide variety of generalized and ocular signs which can result in chronic and disabling sequelae. Here we report two cases of patients suffering with Lyme disease who developed a rare associated papillitis.
A 48-year-old Scottish man presented with diminished visual acuity, painful ocular eye movements, photophobia, and mild ataxia. Fundus examination revealed bilateral disc swelling with associated hemorrhages in the right eye. Following exclusion of raised intracranial pressure as the cause of the findings, enzyme-linked immunosorbent assay and Western blot serology confirmed a positive result for Borrelia burgdorferi which, along with ophthalmic signs and exposure to an endemic area, confirmed the diagnosis of Lyme disease. A 79-year-old gentleman presented with intermittent short-duration "gray film" in his left eye. Fundus examination revealed left optic disc swelling. He was positive for Lyme's serology and his condition was treated with 2 weeks of intravenous ceftriaxone.
The first patient's inflammation resolved and visual acuity returned to normal following a course of high-dose steroids and intravenous ceftriaxone, followed by oral doxycycline. The second patient's condition improved with high-dose intravenous ceftriaxone.
These patients highlight the fact that Lyme disease should be considered as a differential diagnosis for patients presenting with papillitis. With the incidence of this disease rising and more cases being reported, practitioners in Lyme-endemic areas need to be aware of the various manifestations so that appropriate referrals for treatment can be made.
Borrelia burgdorferi; Lyme disease; ocular papillitis
PMID: 22888207 [PubMed] PMCID: PMC3413342 Free PMC Article
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Cornea. 2013 Jan;32(1):87-90. doi: 10.1097/ICO.0b013e318243e45c.
Oculopalpebral borreliosis as an unusual manifestation of Lyme disease.
To report the case of acrodermatitis chronica atrophicans as an ocularpalpebral manifestation of Lyme borreliosis, with peripheral keratopathy and associated vasculitis.
A 16-year-old girl, with a 4-year history of recurrent left eye photophobia, intense redness, and superior eyelid edema, presented with lid erythema, ptosis, superficial venous tortuosity, conjunctival hyperemia, corneal thinning with precipitates, and vascularization. Borrelia burgdorferi was confirmed by immunoblotting. Treatments with doxycycline followed by ceftriaxone were only partially effective. Eyelid biopsy revealed spirochetes and vasculitis with deposition of immunoglobulin G. Oral cefuroxime for 28 days was ineffective. Due to the vasculitis, immunosuppression with azathioprine and topical cyclosporine were given for 4 months. Since then she has been free of flare-ups.
Lyme borreliosis should be considered in patients with recurrent chronic lid edema and associated keratopathy.
PMID: 22495033 [PubMed - indexed for MEDLINE]
J Neuroophthalmol. 2012 Sep;32(3):246-8. doi: 10.1097/WNO.0b013e318234dafc.
Lyme-associated orbital inflammation presenting as painless subacute unilateral ptosis.
- 1College of Physicians and Surgeons, Columbia University, New York, NY, USA.
A 90-year-old woman presented with subacute painless left ptosis. Examination of the left eye revealed ptosis with loss of the superior eyelid sulcus, 2 mm of proptosis, mild tenderness with retropulsion, and optic disc edema. Levator function and extraocular movements were normal, and there was no relative afferent pupillary defect.
MRI demonstrated thickening of the extraocular muscles in the left orbit with lacrimal gland enlargement and mild enhancement of the optic nerve sheath. Serology revealed a positive enzyme-linked immunosorbent assay for Lyme antibodies and a positive Western blot of Lyme IgG titer. The patient recalled a tick bite 6 months earlier, at which time Lyme serologies were negative.
After 3 weeks of intravenous ceftriaxone, she had a significant improvement and a full recovery by 3 months. Lyme disease should be included in the differential diagnosis of orbital inflammation, especially in Lyme-endemic areas.
PMID: 21956017 [PubMed - indexed for MEDLINE]
J Fr Ophtalmol. 2012 Jan;35(1):17-22. doi: 10.1016/j.jfo.2011.03.015. Epub 2011 Jun 22.
[Ocular Lyme disease occurring during childhood: five case reports].
[Article in French]
- 1Service d'Ophtalmologie, Nouvel Hôpital Civil, CHU de Strasbourg, BP 426, 67091 Strasbourg cedex, France. email@example.com
Lyme borreliosis (LB) is the most common human tick-borne disease in the Northern hemisphere. The various ophthalmologic manifestations of Lyme borreliosis (LB) during childhood are discussed in this paper.
Six children with LB-associated ocular manifestations were treated between 2000 and 2010 in the ophthalmology department of Strasbourg University Hospital (an endemic area). Medical history, ocular and systemic clinical findings, determinations of antibodies related to Borrelia, as well as exclusion of other causes were the diagnosis criteria.
Two cases of uveitis, two cases of abducens palsies, one case of optical neuropathy, and one case of orbital myositis associated with LB were diagnosed. Systemic findings, such as arthritis, rash, or erythema migrans were mentioned in all cases. Two children also complained of severe knee arthritis. Determination of antibodies was positive in all patients. They were all treated with antibiotics adjusted to individual circumstances and some of them (two cases of uveitis and one of optic neuropathy) also had anti-inflammatory treatment. Resolution of ocular signs, with no relapse, was observed in all patients within two to 12 weeks.
For any unexplained ocular symptom, even in children, LB should be taken into account, especially in endemic areas. Such patients should undergo serological testing. If the clinical presentation is suggestive of LB, a course of oral antibiotics should be used. All in all, permanent defects are extremely rare during the childhood period, even following long-term manifestation at an early age.
Ophthal Plast Reconstr Surg. 2009 Jul-Aug;25(4):328-30. doi: 10.1097/IOP.0b013e3181aad642.
Management of tick infestation of the eyelid.
Tick infestation of ocular tissues is not common. Tick inoculation of the skin can locally lead to granuloma and abscess formation. More concerning, however, is the potential systemic sequelae that can result from transmission of zoonoses such as Lyme disease, Rocky Mountain spotted fever, Ehrlichia, and tularemia. To avoid these complications, it is critical that the tick is completely removed. The authors present a case of tick infestation in the eyelid of a 55-year-old woman and review the management of such a case.
PMID: 19617802 [PubMed - indexed for MEDLINE]
PATIENTS AND METHODS:
Eur J Ophthalmol. 2009 Mar-Apr;19(2):307-9.
Bartonellosis causing bilateral Leber neuroretinitis: a case report.
Bartonella henselae is the causal agent of cat scratch disease and one variation in its presentation is Leber neuroretinitis. The unilateral presence of exudation as a macular star and papilledema represent its most common presentation.
Observational case report. A 7-year-old girl presented a sudden decrease of visual acuity and bilateral macular exudation (macular star) as well as choroiditis.
A complete recovery of visual acuity was seen after a 6-week follow-up. Erythromycin plus deflazacort treatment was given.
The present case represents an unusual variety of cat scratch disease. This represents a challenge in the differential diagnosis of diseases such as Lyme disease and tuberculosis among others.
PMID: 19253255 [PubMed - indexed for MEDLINE]
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[Anterior optic neuropathy in Lyme disease, monosymptomatic form].
[Article in Romanian]
- 1Clinica Oftalmologie, Universitatea de Medicina Si Farmacie Iuliu Hatieganu Cluj Napoca, Spitalul Clinic Judetean de Urgenta Cluj Napoca.
We present the case of a patient (a 21-year-old woman) with acute and complete loss vision of the left eye, and severe periodic left ocular and left orbital pain. Visual, acuity right eye = 20/20. Under steroid and nonsteroid general and local treatment, the visual acuity was improved (VA left eye = 0, 1,n.c.) and a central scotoma was developed.
Ophthalmoscopic analysis of the left eyeshowed elevated and blurred optic disk margins, retinal hemorrhages, venous congestion. The diagnosis of borreliosis was based on clinical and ocular findings and determinations of antibodies to Borrelia burgdorferi by enzyme-linked immunosorbent assay and immunoblot analysis, the detection of DNA of B.burgdorferi by polymerase chain reaction and exclusion of other infectious and inflammatory causes (tuberculosis, toxoplasmosis, syphilis and sarcoidosis were excluded).
The commonly used blood, urine and spinal fluid tests, cerebral MRI and angiofluorography were also done. The patient received oral ceftriaxone 2gr/daily for 4 weeks, 2 cures and Doxycycline 2 gr/daily, 21 days.
Under the treatment, the clinical signs had significantly improved (VA left eye = 20/20), but the central scotoma remained. The case is unusual because only one eye was affected (typically decreased visual acuity occurs on both eyes), other signs of the disease were absent, and the recovery under the antibiotic treatment was excellent.
PMID: 19149119 [PubMed - indexed for MEDLINE]
Int Ophthalmol. 2010 Oct;30(5):599-602. doi: 10.1007/s10792-008-9268-5. Epub 2008 Oct 15.
Cotton wool spots as possible indicators of retinal vascular pathology in ocular lyme borreliosis.
- 1Augenaerzte Gurtengasse, 3011, Bern, Switzerland. firstname.lastname@example.org
Lyme borreliosis is an underdiagnosed infectious disease caused by a spirochete and transmitted by certain Ixodes ticks. In Lymedisease diagnostic problems are still discussed extensively as the laboratory workup is not standardized and a positive antibody result is not proof of active infection. It is therefore important to appreciate all clinical signs that can prompt us to the diagnostic investigation of Lyme borreliosis.
We present a case of a woman with Lyme borreliosis and recurrent unilateral anterior uveitis in her right eye for 2 years, who developed cotton wool spots (CWS) in her left eye, followed by acute and recurrent anterior uveitis in this second eye. An extensive general examination, including blood coagulopathies and ultrasound of the carotid arteries, did not reveal any pathology. The CWS resolved within a few months.
The recurrent anterior uveitis could be controlled by topical steroids. After treatment with 2 g of i.v. ceftriaxone for 3 weeks, she remained free of recurrences for 1 year of observation time. CWS can be the first clinical sign of ocular vascular pathology and/or uveitis. Further investigation will be necessary to confirm the relationship between CWS and ocular borreliosis. In patients with otherwise unexplained CWS, the possibility of an infection with borreliosis should be ruled out carefully.
PMID: 18854948 [PubMed - indexed for MEDLINE]