Ocular inflammation as a manifestation of Lyme borreliosis

We read with interest the recent article ‘Tick bite and early Lyme borreliosis’ 1. Lyme disease has a number of important ophthalmic manifestations which we feel it is important to highlight. A self limited follicular conjunctivitis is probably the most common early ocular manifestation and usually occurs within the first few weeks of infection in around 10% of patients. Periorbital oedema has also been reported to occur in the early stage. 2, 3. Ocular involvement also includes anterior, intermediate and posterior uveitis, keratitis and episcleritis.3.

Among all uveitis cases, 4.3% of patients were found to have Lyme as the underlying cause; and all patients with lyme uveitis had posterior ocular manifestations, such as vitritis, retinal vasculitis or neuroretinitis.4

Photophobia and severe periodic ocular pain can be characteristic symptoms of Lyme borreliosis 3. Doctors should be aware that patients presenting with eye pain, redness, photophobia or reduced visual acuity could have ocular manifestations of Lyme disease.

1. Duncan CJA, Carle G, Seaton A. Tick bite and early Lyme Borreliosis. BMJ 2012;344:e3124
2. Weinberg RS. Ocular Involvement in Lyme disease. Current Insight - American Academy of Ophthalmology 2008
3. Mikkila HO, Ilkka JT, Seppala I, Viljanen MK, Peltomaa MP, Karma A. The Expanding Clinical Spectrum of Ocular Lyme Borreliosis
Ophthalmology 2000;107:581–587
4. Mikkila H, Seppala I, Leirisalo-Repo M, Immonen I, Karma A. The etiology of uveitis: the role of infections with special reference to Lyme borreliosis. Acta Ophthalmologica Scandinavica, 12 1997, vol./is. 75/6(716-9).
　

Competing interests: None declared