Aim: To present the case of a young adult who developed a cranial nerve palsy as a result of Lyme disease. Methods: The case of a 22-year-old male medical student who contracted Lyme disease after visiting a deer park in Oxford is discussed. A full orthoptic and ophthalmic examination was performed. The case outlines the difficulty the patient experienced in getting a diagnosis and eventually being appropriately treated. Results: The patient had an isolated sixth nerve palsy which resulted from being bitten by an infected tick at a deer park which caused Lyme disease to develop. The patient developed erythema migrans, a bull'seye-shaped rash, on his leg where he had been bitten, but believed this to be ringworm. No other obvious symptoms of Lyme disease developed, which resulted in the patient himself investigating further to reach a diagnosis. Once diagnosed the patient was given a course of the antibiotic ceftriaxone intravenously for 4 weeks. Lyme disease is described as a noncontagious uncommon infection that can spread to the skin, heart, joints and nervous system. Conclusions: Orthoptists and ophthalmic specialists should be aware that if the diagnosis is uncertain Lyme disease could be the cause.