Optic nerve involvement in Lyme disease

Abstract

Optic neuropathy in Lyme neuroborreliosis is rare. The cases reported in the literature are not sufficient for making a list of clinical 'red flags'. However, in adult cases, special attention seems reasonable in patients with painless visual loss, bilateral optic nerve head swelling with or without an elevated cerebrospinal fluid opening pressure. In endemic areas, any optic neuropathy may still be considered for a Lyme neuroborreliosis work-up. The use of accepted criteria for establishing the diagnosis of Lyme neuroborreliosis is emphasised.

Lyme disease associated neuroretinitis — Case report

“…Very few cases of retrobulbar optic neuritis, papillitis, neuroretinitis and ischemic optic neuropathy have shown evidence of a strong association with Lyme neuroborreliosis and there are suffi cient evidence between Lyme disease and posterior uveitis [6]. Optic neuropathy in Lyme neuro-borreliosis is a typi- cally rare complication.…”

“…Optic neuropathy in Lyme neuro-borreliosis is a typi- cally rare complication. However, in adult cases, special attention seems reasonable in patients with unilateral painless visual disturbance, bilateral optic nerve head swelling with or without an elevated cerebrospinal fl uid opening pressure [1,3,5,6]. The differential diagnosis in a patient with subtle optic disc oedema and subretinal fl uid includes both infectious and non-infectious entities.…”

“…Cranial neuropathies are common, but neuroretinitis has been reported in a few isolated cases. The relationship between neuroretinitis and Lyme disease has not been established and the result of recent studies remains controversial [1][2][3][4][5][6]. We describe the case history of a patient with Lyme disease complicated by neuroretinitis in the right eye and incomplete empty sella.…”

Lyme Disease: Knowing Good Evidence to Help Inform Practice

“…These articles also help catalog the conditions that either are extraordinarily rare or have no clearly defined association with Lyme disease but are tenuously grasped by some based perhaps on chance coincidence, such as "congenital" Lyme disease, cardiomyopathy, hearing loss, optic neuritis, multiple sclerosis, Alzheimer disease, Parkinson disease, or amyotrophic lateral sclerosis. [17][18][19][20][21][22] Knowledge regarding Lyme disease is only a part of what clinicians should know regarding illnesses that could represent other potential infections transmitted by the black-legged deer tick. Excellent reviews covering these aspects include human granulocytic anaplasmosis by Dumler and Bakken (See article by Dumler and Bakken, "Human Granulocytic Anaplasmosis", in this issue) and babesiosis by Krause and colleagues (See article by Krause and colleagues, "Babesiosis", in this issue).…”

Corticosteroids and Anti-Complement Therapy in Retinal Diseases

“…Optic nerve involvement in Lyme disease, or Lyme borreliosis, may include neuroretinitis, optic neuritis, ischemic optic neuropathy, or swelling of the optic disc (Bhatti 2007;Traisk and Lindquist 2012). Diagnosis may be challenging and relies on a combination of clinical involvement, risk of tick exposure, history of a classic rash, and either microbial or serologic evidence for disease.…”