The expanding clinical spectrum of ocular lyme borreliosis.

Mikkila HO, Seppala IJ, Viljanen MK, Peltomaa MP, Karma A.

Department of Ophthalmology, Helsinki University Central Hospital,
Finland.

OBJECTIVE: To delineate the clinical manifestations of ocular Lyme
borreliosis, while concentrating on new symptoms and findings and the
phase
of appearance of ophthalmologic disorders. DESIGN: Observational case
series. PARTICIPANTS: Ten patients with Lyme borreliosis-associated
ophthalmologic findings previously reported from the Helsinki
University
Central Hospital in addition to 10 new cases that have since been
diagnosed.
INTERVENTION/TESTING: The patients underwent medical and ophthalmologic
evaluation. The diagnosis of Lyme borreliosis was based on medical
history,
clinical ocular and systemic findings, determinations of antibodies to
Borrelia burgdorferi by enzyme-linked immunosorbent assay and
immunoblot
analysis, the detection of DNA of B. burgdorferi by polymerase chain
reaction, and exclusion of other infectious and inflammatory causes.
MAIN
OUTCOME MEASURES: Ocular complaints, presenting ophthalmologic
findings, and
the stage of Lyme borreliosis were recorded. RESULTS: Four patients
presented with a neuro-ophthalmologic disorder, five had external
ocular
inflammation, 10 patients had uveitis, and one had branch retinal vein
occlusion. One patient developed episcleritis and one patient developed
abducens palsy within 2 months of the infection incident. In the
remaining
14 patients in whom the time of infection was traced, the ocular
manifestations appeared in the late stage of Lyme borreliosis. Two
patients
with a neuro-ophthalmologic disorder and one with external ocular
inflammation experienced severe photophobia, whereas the main reported
symptom of the patients with uveitis was decreased visual acuity. Four
patients with external ocular disease and one with a
neuro-ophthalmologic
disorder experienced severe periodic ocular or {*filter*} pain. Retinal
vasculitis developed in seven patients with uveitis. CONCLUSIONS: Lyme
borreliosis can cause a variety of ocular manifestations, which develop
mainly in the late stage of the disease. Photophobia and severe
periodic
ocular pain can be characteristic symptoms of Lyme borreliosis. In the
differential diagnosis of retinal vasculitis, Lyme borreliosis should
be
taken into account, especially in endemic areas.

Publication Types:
Case Reports

PMID: 10711899 [PubMed - indexed for MEDLINE]