Diagnosis and Clinical Characteristics of Ocular Lyme Borreliosis

Clinical approach to optic neuritis: pitfalls, red flags and differential diagnosis

“…However, as in case 4, a painful eye movement is sometimes reported in patients with mucoceles [Avery et al 1983;Rothstein et al 1984] or arterial aneurysms [Petzold, 2008] ON without signs for other demyelinating CNS disease Chronic relapsing inflammatory optic neuropathy (CRION) [Kidd et al 2003] Often bilateral, severe and painful visual loss, relapse after withdrawal of steroids Neuromyelitis optica (NMO) [Wingerchuk et al 2007] ON and transverse myelitis Acute disseminated encephalomyelitis (ADEM) [Tenembaum et al 2007] Usually monophasic, triggered by infections and vaccination, encephalomyelitis, can be bilateral Connective tissue disorders and vasculitis [Theodoridou and Settas, 2006;Cikes et al 2008] Worsening of symptoms after withdrawal of steroids Sarcoidosis Progressive or relapsing severe visual loss, often very painful Systemic lupus erythematosus (SLE) Rare, often unilateral, sometimes associated with transverse myelitis Sjögren's syndrome Often bilateral, severe visual loss Antiphospholipid antibody syndrome Rare, often unilateral, sometimes associated with transverse myelitis Behçet's disease Papillitis, uveitis, chorioretinitis, and retinal vasculitis Wegener's granulomatosis Papillitis, scleritis, conjunctivitis, uveitis, retinal vasculitis Giant cell arteritis (GCA) [Carroll et al 2006] Sudden visual loss (AION, PION), headache, muscle pain, age >50 years, jaw claudication Other inflammatory optic neuropathies Postinfectious and postvaccination Bilateral, often in childhood, good prognosis Neuroretinitis [Ray and Gragoudas, 2001] Swollen optic disc and macular star, spontaneous recovery TolosaHunt syndrome [La Mantia et al 2006] Painful ophthalmoplegia Infectious optic neuropathies Progressive visual loss with exposure to infectious agent Lyme disease [Karma et al 1995] Rare, more often occurring at later stages of disease Syphilis Also manifestation as uveitis, retinitis Tuberculosis [Bodaghi and LeHoang, 2000] Rare, more often presenting as choroiditis or uveitis Viral optic neuritis Most frequently associated with herpes Zoster infection Compressive optic neuropathies Painless and progressive visual loss Primary tumours (meningiomas, gliomas, and pituitary tumours) [Eddleman and Liu, 2007] Optic atrophy Metastases History of or evidence for primary tumour Thyroid ophthalmopathy [Vardizer et al 2010] Protrusion of one or both eyes, dry eyes, systemic signs for hyperthyroidism Arterial aneurysms Painful progressive visual loss, general headache Sinus mucoceles History of sinusitis, may be painful and with subacute visual loss Ischemic optic neuropathies [Fontal et al 2007] Sudden onset of painless visual loss, age >50 years Anterior ischaemic optic neuropathy (AION) Swollen optic disc Posterior ischaemic optic neuropathy (PION) Optic di...…”

The etiology of uveitis: The role of infections with special reference to Lyme borreliosis

“…The clinical manifestations of Lyme borreliosis are extremely varied (Steere 1989). Ocular Lyme borreliosis was first reported in 1985 (Steere et al 1985) and since then case reports and small series of patients with ocular Lyme borreliosis have been published (Winward et al 1989;Smith 1991;Karma et al 1995).…”

Management Of Neuroretinitis In A Case of Lyme Disease

“…Ocular features are rare, occur in the form of conjunctivitis, stromal keratitis, episcleritis, vitritis, neuroretinitis,papilledema and crainial nerve palsy (most common 7 th nerve). 3 The incidence of neuroretinitis in Lyme disease is a very rare occurrence. Neuroretinitis is characterized by an inflammation of the optic disc vasculature with exudation of fluid into the peripapillary retina.…”

“…2,3 It is mostly unilateral and may be precipitated by various, known and unknown factors. We present a case of unilateral neuroretinitis in Lyme's disease in a teenager with optimal response to our medical treatment.…”