To delineate the clinical manifestations of ocular Lyme borreliosis, while concentrating
on new symptoms and findings and the phase of appearance of ophthalmologic disorders.
Observational case series.
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.
Ocular complaints, presenting ophthalmologic findings, and the stage of Lyme borreliosis
were recorded.
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 facial pain. Retinal vasculitis developed in seven patients with uveitis.
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.