Ocular Manifestations

Clinical Manifestations and Diagnosis of Lyme Borreliosis

“…In the majority of later series on EM, conjunctivitis was reported only rarely or not mentioned at all. Among 19 European patients with intraocular involvement interpreted as due to borrelial infection, 12 had chorioiditis (bilateral 8, unilateral 4; diffuse or disseminated 8, focal 4), 3 had neuroretinitis, 2 bilateral retinal vasculitis, 1 bilateral iridocyclitis and 1 keratitis [230] . Borrelial infection was demonstrated in all the patients by the presence of borrelial antibodies in serum, and in 9 it was also indicated by the presence of other objective manifestation(s) of Lyme borreliosis (3 patients had lymphocytic meningitis, 1 had meningoradiculitis with second-degree A-V block, 2 had peripheral facial palsy -1 also had lymphocytic pleocytosis, and 3 had oligoarthritis).…”

“…The interval from EM to the onset of eye involvement is variable and may be from a few days to years, conjunctivitis being representative of an early ocular lesion, whereas keratitis appears late in the course of Lyme borreliosis [16,230] .…”

“…Inflammation, particularly when long-lasting, may lead to severe impairment or even complete loss of vision [16,226,[228][229][230] .…”

“…According to the reports on EM that were published soon after Lyme borreliosis was recognized, conjunctivitis was found in as many as 35 of 314 (11%) patients in the USA [230] , whereas in Europe the proportion of patients with EM and conjunctivitis was lower: of 104 patients with EM in southern Germany only 1 had conjunctivitis [53] , and it was found in 23 of 425 (5%) Slovenian patients diagnosed with EM before 1990 [230] and in 10 of 231 (4%) skin culture-confirmed patients diagnosed in 1994 [136] . In the majority of later series on EM, conjunctivitis was reported only rarely or not mentioned at all.…”

“…Patients were treated with antibiotics, and were followed for a median of 12 months (range 3-49 months). Visual acuity, which was initially found impaired in 18 patients (1 patient was not assessed), improved or normalized in the large majority of patients [230] . Huppertz et al [233] reported that 3 of 84 (4%) children and adolescents with Lyme arthritis had ocular inflammation, including keratitis, anterior uveitis and uveitis intermedia.…”