Eye Related Abstracts
Part 2
Klin Padiatr. 1999 Mar-Apr;211(2):70-4.
[Diagnosis and therapy of Lyme borreliosis in children. Practice guideline of the German Society for Pediatric Infectious Diseases]
[Article in German]
Hobusch D, Christen HJ, Huppertz HI, Noack R.
Univ.-Kinder- und Jugendklinik, Rostock.
Lyme borreliosis is the most frequent tickborne++ disease of man in the Northern hemisphere. A variety of systems may be involved. The most frequent manifestations in childhood include erythema migrans, meningitis, cranial nerve palsy and arthritis. Erythema migrans usually is easily recognised and determination of antibodies to Borrelia burgdorferi should not be performed.
Childhood neuroborreliosis is characterised mostly by aseptic meningitis with or without cranial nerve palsy, in most cases facial palsy. Basic CSF findings often show a combined evidence of lymphocytic pleocytosis, IgM-class dominance in intrathecal humoral immune++ response, and blood-CSF barrier dysfunction.
Calculation of the Borrelia burgdorferi specific antibody index (according to Reiber) proved to be the most sensitive method for detecting intrathecal synthesis of specific antibodies. Lyme arthritis presents initially as episodic oligoarthritis, mostly involving the knee joint, and may turn into chronic monoarthritis of the knee; usually high titers of IgG antibodies to Borrelia burgdorferi are found.
The rarer manifestations encephalomyelitis, chronic arthritis, carditis and inflammatory eye disease may be difficult to diagnosis due to clinical ambiguity and problems in the interpretation of serological results.
Antibodies to Borrelia burgdorferi found by sensitive Elisa must always be confirmed by immunoblot analysis, but sometimes immunoblot analysis is more sensitive than Elisa. Treatment is by antibiotics, amoxicillin or doxyciclin for erythema migrans, and i.v. third generation cephalosporins for all other manifestations.
Even after successful antibiotic therapy, antibodies may persist for months and years and no further antibiotic treatment is necessary in the absence of attributable clinical manifestations. The differentiation between a persisting immune response and a persisting infection therefore has to be based upon the clinical symptoms, non-specific laboratory data and the development of the antibody titers.
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Cornea. 1999 Jan;18(1):115-6.
Lyme disease associated with unilateral interstitial keratitis.
Miyashiro MJ, Yee RW, Patel G, Ruiz RS.
Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, 77030, USA.
PURPOSE: To report a case of Lyme disease that presented with a single nummular unilateral interstitial keratitis. METHODS: Case report and review of the literature. RESULTS: A 57-year-old black man who had contact with freshly killed deer had a chief complaint of foreign-body sensation in his right eye (OD) that had been diagnosed and treated for herpes simplex stromal keratitis. The patient underwent a systemic workup for interstitial keratitis. All results including RPR and MHA-TP were negative except for Lyme antibody titer (enzyme-linked immunosorbent assay [ELISA]) 178 U/ml (normal, <159 U/ml). CONCLUSION: Interstitial keratitis from Lyme disease has been regarded as a bilateral disease in the literature. We present this infrequent ocular manifestation of Lyme disease as a rare single nummular unilateral presentation.
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Int Ophthalmol Clin. 1997 Spring;37(2):13-28.
The ocular manifestations of Lyme disease.
New York Medical College, Valhalla, USA.
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.
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Klin Oczna. 1997;99(2):129-32.
[Clinical manifestation and diagnosis of ocular borreliosis]
[Article in Polish]
Biziorek B, Zagórski Z, Jedrzejewski D, Haszcz D.
Katedry i l Kliniki Okulistyki AM w Lublinie.
PURPOSE: To present severe involvements of Borrelia burgdorferi in the etiology of uveitis, optic neuritis and other ocular inflammatory conditions.
METHODS: IgM and IgG antibodies for Borrelia burgdorferi were detected by ELISA. Since May 1995 we have examined 78 patients for borreliosis.
RESULTS: Borreliosis was diagnosed in 11 patients (4 males, 7 females; aged 7 to 48). 7 persons remembered being bitten by a tick, 3 months to 3 years before the onset of ocular symptoms. All patients had systemic symptoms and signs.
Ocular manifestations were as follows: nonspecific chronic conjunctivitis in 4 patients, keratitis in 2, diminished corneal sensation in 1, iritis in 1, intermediate uveitis and perivasculitis in 1, posterior uveitis in 3, retinal haemorrhage in 1, optic neuritis in 1, optic disc oedema in 2, sixth nerve paresis in 1 patient.
CONCLUSIONS: We emphasize the importance of performing serological tests for borreliosis in patients with uveitis, inflammatory diseases of unknown etiology, optic neuritis and other neuro-ophthalmic conditions.
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Am J Med. 1995 Apr 24;98(4A):60S-62S.
Ocular manifestations of Lyme disease.
Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA.
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.
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Am J Ophthalmol. 1995 Feb;119(2):127-35.
Comment in:
Am J Ophthalmol. 1995 Aug;120(2):263-4.
Diagnosis and clinical characteristics of ocular Lyme borreliosis.
Karma A, Seppälä I, Mikkilä H, Kaakkola S, Viljanen M, Tarkkanen A.
Department of Ophthalmology, University of Helsinki, Finland.
PURPOSE: To establish a diagnosis, in a group of patients we studied the characteristics of ocular Lyme borreliosis.
METHODS: During a two-year period, 236 patients with prolonged external ocular inflammation, uveitis, retinitis, optic neuritis, or unexplained neuro-ophthalmic symptoms were examined for Lyme borreliosis. Antibodies to Borrelia burgdorferi were measured by indirect ELISA and western blot. Cerebrospinal fluid was also analyzed by polymerase chain reaction.
RESULTS: Ocular Lyme borreliosis was diagnosed in ten patients on the basis of medical history, clinical findings, and serologic test results. Results of ELISA disclosed that five patients were seropositive, two patients showed borderline reactivity, and three patients were seronegative.
Four of the five patients with borderline or negative results by ELISA had a positive result by western blot analysis. In one seropositive patient, polymerase chain reaction verified a gene of B. burgdorferi endoflagellin from the vitreous and cerebrospinal fluid specimen. In five of the six patients with known onset of the Borrelia infection, the ocular disorder appeared as a late manifestation.
Abnormalities of the posterior segment of the eye, such as vitreitis, retinal vasculitis, neuroretinitis, choroiditis, and optic neuropathy were seen in six patients. Bilateral paralytic mydriasis, interstitial keratitis, episcleritis, and anterior uveitis were seen in one patient each.
CONCLUSIONS: Late-phase ocular Lyme borreliosis is probably underdiagnosed because of weak seropositivity or seronegativity in ELISA assays. Ocular borrelial manifestations show characteristics resembling those seen in syphilis.
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nt Ophthalmol Clin. 1993 Winter;33(1):9-22.
The ocular manifestations of Lyme disease.
Department of Ophthalmology, Westchester County Medical Center Valhalla, NY 10595.
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.
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Dermatol Clin. 1992 Oct;10(4):763-75.
Lyme disease.
Department of Dermatology, New York University School of Medicine, New York.
Lyme disease is a multisystem disorder caused by the spirochete Borrelia burgdorferi. It is transmitted to human and animal hosts primarily by ticks of the Ixodes ricinis complex. Recognition of its characteristic skin and eye manifestations facilitates diagnosis and treatment.
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Klin Monatsbl Augenheilkd. 1992 Aug;201(2):83-91.
[Ocular findings in infection with Borrelia burgdorferi]
[Article in German]
Augenklinik, Medizinischen Fakultät, Rheinisch-Westfälischen Technischen Hochschule Aachen.
During the years 1988 to 1990 ten patients were observed in the eye clinic of RWTH Aachen with ocular findings of infection with Borrelia burgdorferi. 6 of them showed neuro-ophthalmological signs, 4 had uveitis. In both groups recent infections were documented in fresh and chronic stages of the disease, lasting longer than one year.
The various clinical pictures of the disease following infection with Borrelia burgdorferi are described. As a vaccination against Borreliosis is not yet available, it is important to detect the antibodies against Borrelia burgdorferi early enough, to initiate an effective treatment.
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Ned Tijdschr Geneeskd. 1991 Aug 17;135(33):1500-2.
[Aspecific eye disorders in Lyme disease]
[Article in Dutch]
Academisch Ziekenhuis, afd. Oogheelkunde, Leiden.
Lyme disease shows a large variety of clinical signs and symptoms. Ocular disease may occur in the disseminated stage of the disease. Ocular signs are often not specific of Lyme disease.
In the presence of unexplained ocular disease it may be wise to consider Lyme disease as a possible diagnosis. Diagnosis and therapy in two Lyme disease patients with ocular disease are discussed.
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Neurol Clin. 1991 Feb;9(1):35-53.
Neuro-ocular Lyme borreliosis.
Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida.
Any patient who has a Bell's palsy (unilateral or bilateral), aseptic meningitis, chronic fatigue syndrome, atypical radiculoneuropathy, presenile dementia, atypical myopathy, or symptoms of atypical rheumatoid arthritis should be asked specifically about the following: visits to highly endemic areas, any known tick bites, any skin lesion suggestive of erythema migrans, any history of palpitations or of prior Bell's palsy, aching in joints (especially the knees), paresthesias, chronic fatigue and depression, forgetfulness, and eye problems.
Any patient showing a chronic iritis with posterior synechiae, vitritis in one or both eyes, an atypical pars planitis-like syndrome, big blind spot syndrome, and swollen or hyperemic optic discs should be asked the same questions.
The physician should send one red-top tube of blood containing 2 to 3 ml serum to Microbiology Reference Laboratory, 10703 Progress Way, Cypress, CA 90630-4714, requesting a Lyme/treponemal panel. For $90 the patient will receive an RPR test with titer, serum FTA-ABS test, serum Lyme IFA IgG and IgM, and a serum Lyme ELISA test.
If these tests are within normal limits and the physician is still suspicious, a Western blot can be ordered on serum. A green top tube with fresh white blood cells sent out by overnight express on a Monday or Tuesday will produce a Lyme PCR and a lymphocyte stimulation test.
Finally, R.K. Porschen, director of MRL Laboratory, will provide information on the urine antigen test on an investigational basis. A careful history with emphasis on the specific questions noted above, a complete neuro-ophthalmological and physical examination ruling out other causative problems, and the laboratory studies here discussed will usually provide sufficient data to choose therapy.
Much further active research into Lyme borreliosis is an important priority in medicine.
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Ophthalmology. 1990 Jun;97(6):699-706.
Neuro-ophthalmologic manifestations of Lyme disease.
Lesser RL, Kornmehl EW, Pachner AR, Kattah J, Hedges TR 3rd, Newman NM, Ecker PA, Glassman MI.
Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT 06510.
Lyme disease is a tick-borne spirochetal infection characterized by skin rash, neurologic, cardiac, and arthritic findings. The authors report six patients with Lyme disease who had neuro-ophthalmologic manifestations. One patient had meningitis with papilledema, two had optic neuritis, and one had neuroretinitis.
Three patients had sixth nerve paresis, two of whom cleared quickly, whereas multiple cranial nerve palsies and subsequent optic neuropathy developed in another. Early recognition of neuro-ophthalmologic findings can help in the diagnosis and treatment of Lyme disease.
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Br J Ophthalmol. 1990 Jun;74(6):325-7.
Ocular Lyme disease: case report and review of the literature.
New York Medical College, Valhalla 10595.
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.
PMID: 2198927 [PubMed - indexed for MEDLINE]
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Am J Ophthalmol. 1989 Dec 15;108(6):651-7.
Ocular Lyme borreliosis.
Winward KE, Smith JL, Culbertson WW, Paris-Hamelin A.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida 33101.
In six patients with ocular Lyme borreliosis, bilateral granulomatous iridocyclitis and vitritis were present in five. One of these five also had bilateral optic neuritis. Another patient developed combined trochlear and facial nerve palsies.
A syndrome resembling pars planitis with atypical features such as granulomatous keratic precipitates and posterior synechiae should prompt a search for Lyme borreliosis.
Topical corticosteroid therapy is necessary to prevent complications of anterior segment inflammation caused by Lyme uveitis, but the benefit of systemic and periocular corticosteroids is uncertain.
Oral antibiotics may be effective in treating early stages of ocular Lyme borreliosis. In later stages, intravenous antibiotic therapy is indicated.
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J Clin Neuroophthalmol. 1989 Sep;9(3):148-55.
The prevalence of Lyme disease in a nonendemic area. A comparative serologic study in a south Florida eye clinic population.
Smith JL, Parsons TM, Paris-Hamelin AJ, Porschen RK.
Bascom Palmer Eye Institute, Miami, Florida.
Serologic tests for Lyme borreliosis and for syphilis were performed on 75 patients seen in a 1-week period at the Bascom Palmer Eye Institute in Miami. The incident of syphilis was 8% and of Lyme borreliosis 3% in this study in a nonendemic area.
The most common cause for a high titer serologic response for Lyme borreliosis in this group was a prior Treponema pallidum infection. The importance of getting VDRL, FTA-ABS, Lyme IFA, and Lyme ELISA tests in all suspected cases was emphasized.
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J Am Optom Assoc. 1989 Apr;60(4):284-9.
Ocular manifestations of Lyme disease.
F.D.R. V.A. Hospital, Montrose, NY 10548.
The incidence of Lyme disease has been increasing at alarming rates in recent years. Being the most commonly reported tickborne bacterial disease in the United States, it now outnumbers Rocky Mountain spotted fever by a ratio of almost 2:1.
It is a multisystem illness and can manifest itself with dermatologic, neurologic, cardiac and rheumatologic involvement. The ocular complications of Lyme disease can present as one of the more ominous signs during the course of the illness.
The detection of the disease and proper referral by the optometrist may permit more appropriate treatment, and thus, a better prognosis of the illness.
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Am J Ophthalmol. 1988 Jan 15;105(1):75-7.
Bilateral keratitis as a manifestation of Lyme disease.
Baum J, Barza M, Weinstein P, Groden J, Aswad M.
Department of Ophthalmology, New England Medical Center, Boston, MA 02111.
An 11-year-old girl developed bilateral keratitis, which we believe was a manifestation of Lyme disease. She had had several attacks of Lyme arthritis and was twice treated with parenteral penicillin.
The keratitis developed five years after the initial episode of Lyme arthritis at a time when there were no other manifestations of Lyme disease. It cleared completely in both eyes after topical corticosteroid therapy.
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J Clin Neuroophthalmol. 1987 Dec;7(4):185-90.
Lyme disease. A neuro-ophthalmologic view.
Department of Pathology, Southampton Hospital, NY 11968.
Lyme borreliosis is a spirochetal infection with a potential to produce a clinical disease in the human host with protean manifestations as diverse as the spectrum of disease caused by Treponema pallidum.
Neuro-ophthalmologic manifestations of Lyme borreliosis are emphasized in this short review. A brief historical chronicle of Lyme disease is offered. Potential pitfalls in the diagnosis of Lyme disease with an emphasis on false negative serology and currently available diagnostic modalities are presented. Therapeutic options for Lyme borreliosis are briefly reviewed.
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Proc Soc Exp Biol Med. 1986 Feb;181(2):263-9.
The histopathology of experimentally infected hamsters with the Lyme disease spirochete, Borrelia burgdorferi.
Seven hamsters, experimentally infected with Borrelia burgdorferi, were examined by both cultural and histological techniques at 1 to 9 months postinfection. Spirochetes were detected in the spleen, kidney, or eye of all animals by culture and in the spleen, kidney, eye, liver, or heart blood of five of seven animals by histological examination.
Two animals showed nonspecific hepatic portal lymphocytic infiltration, while five of the hamsters displayed no significant histologic signs of inflammation or granuloma formation in the major organ systems. Synovitis and arthropathy did not occur.
All animals showed some degree of follicular lymphoid hyperplasia of the spleen. Spirochetes were predominantly extracellular with a rare organism appearing to be partially within a macrophage.
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Ann Intern Med. 1985 Sep;103(3):382-4.
Unilateral blindness caused by infection with the Lyme disease spirochete, Borrelia burgdorferi.
Steere AC, Duray PH, Kauffmann DJ, Wormser GP.
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University of Illinois Lyme Disease and the Eye
Reviewed: Last Updated: 5/01/91 Created: 5/01/91
How does lyme disease affect the eye? Fortunately, involvement of the eye is uncommon in lyme disease. But when the eyes can be affected in many different ways by the disease.
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.