Lyme disease in eyes

Uveitis is inflammation of the uvea, a thin layer of tissue within the eye. Symptoms include blurred vision, eye pain and redness. In cases where uveitis comes from Lyme disease, it typically occurs in stage two of the disease, at around 3-12 weeks after infection.

Photophobia is characterised by sensitivity, pain or headaches when the eyes are exposed to light. Light sensitivity can be due to a problem with the eyes or the neurological system. It occurs in up to 16% of people with Lyme disease (Sources: J Neuroophthalmol, Quality of Life Research).

Conjunctivitis is inflammation of the conjunctiva, the membrane that covers the eye’s surface. Symptoms include redness (often called pink eye), soreness and itching. It’s thought that around 10% of people with Lyme disease will develop conjunctivitis during stage 1 of the disease (Source: AAO).

In the early stages of Lyme disease, bloodshot eyes can be due to conjunctivitis. The blood vessels become irritated, swollen and red, causing the bloodshot effect.

Lyme disease can cause an eye twitch and muscle twitching anywhere on the body due to neurological effects of the infection.

Red eyes are a sign of conjunctivitis that may indicate early-stage Lyme disease if accompanied by other relevant symptoms.

Lyme disease can cause eye inflammation in different parts of the eyes, particularly the uvea (uveitis) or the choroid (choroiditis).

The bacteria in Lyme disease can cause uveitis, which often causes dry eyes and redness, blurred vision, and eye pain.

People with Lyme disease can report tired eyes and a feeling of general exhaustion that doesn’t resolve with sleep.

Although the research is limited, some reported cases of vision loss are associated with Lyme borreliosis (Sources: BMJ, Br J Ophthalmol). It remains unclear exactly how this tick-borne disease affects eyesight. However, we know it can cause inflammation of the optic nerve (optic neuritis), the uvea (uveitis) or choroid (choroiditis), which can all affect vision. Lyme disease can also damage the blood vessels (retinal vasculitis), which could cause vision loss (Source: National Library of Medicine).

If the Borrelia burgdorferi bacteria enters the brain and nervous system, it can cause meningitis or neurological effects that could impact vision and cause blindness. It seems that treating the underlying Lyme disease halts or improves vision loss.

A bull’s eye rash around a known tick bite is enough to make a diagnosis and start treatment right away (Source: NICE). Otherwise, most countries advise blood tests to detect antibodies as the first step in diagnosing Lyme disease (Sources: NHS, CDC, ECDC). However, Lyme borreliosis is hard to diagnose, and blood tests (ELISA and Immunoblot) are not always conclusive.

In some cases, your doctor may refer you to a specialist in infectious diseases who can also test for tick-borne co-infections. If you have eye symptoms of Lyme disease, you may need eye care from an ophthalmology clinic.

The only prevention for Lyme disease is to avoid being bitten by a tick. If you live in a known tick high-risk area or are walking in grassy forest areas, wear long trousers so that ticks can’t attach to your legs or ankles, and use insect repellent.

A long-term course of antibiotics is the standard treatment for Lyme disease. Depending on your symptoms, you might take antibiotics as tablets (doxycycline, amoxicillin or azithromycin) or directly into your vein as an IV infusion (ceftriaxone) (Source: NICE). Treatment is usually effective and should improve or resolve symptoms.