Related Experiment Videos
Ocular manifestations of Lyme disease
1Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA.
Abstract:
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.
Insights
Ocular Lyme disease, though rare, involves early spirochete invasion causing conjunctivitis, keratitis, and uveitis. Diagnosis requires ruling out other conditions and positive serology for effective intravenous treatment.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Neuroscience
Background:
- Ocular manifestations of Lyme disease are rare but significant.
- The spirochete responsible for Lyme disease can invade the eye early, leading to both early and late symptoms.
Purpose of the Study:
- To review the spectrum of ocular manifestations associated with Lyme disease.
- To outline diagnostic criteria and management strategies for ocular Lyme disease.
Main Methods:
- Review of existing literature on ocular Lyme disease.
- Analysis of reported cases and clinical presentations.
Main Results:
- Common early manifestation: nonspecific follicular conjunctivitis (approx. 10%).
- Keratitis characterized by nummular opacities occurs within months.
- Inflammatory syndromes (vitritis, uveitis) and neuro-ophthalmic issues (neuroretinitis, optic atrophy) are reported.
- Seventh nerve paresis can cause neurotrophic keratitis; Lyme disease is a significant cause of Bell's palsy in endemic areas.
Conclusions:
- Establishing Lyme disease as the cause of ocular findings requires excluding other diseases, consistent clinical signs, endemic area residence, positive serology, and treatment response.
- Management of ocular Lyme disease frequently necessitates intravenous antibiotic therapy.