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The following article was published in Your Health Magazine. Our mission is to empower people to live healthier.
Michael J. Dodd, MD
Lyme Disease and the Eye
Maryland Eye Associates
. http://marylandeyeassociates.com

Lyme Disease and the Eye

Lyme disease is an infectious disease that was first described in Old Lyme, Connecticut in 1975. It is caused by a spiral-shaped bacteria (spirochete) called Borrelia burgdorferi. This organism is transmitted to humans by a deer tick, Ixodes scapularis. The deer tick actually gets the bacteria from small rodents but since the tick follows deer populations and can also bite people, and is the vector for the infection, it is referred to as a deer tick.

The tick is tiny and often missed when it first bites the skin. As it fills with blood it expands and is more obvious. If the tick is removed in the first day or two, the Lyme infection may be avoided. Many patients who become infected may not realize it. Some patients get a round, red, circle at the site of the bite on the skin called a “bull's eye rash.” The medical term is “erythema migrans.” From this site the bacteria can spread through the blood stream to anywhere in the body. Organisms have been found in the heart, joints, nervous system and eyes. Interestingly, these ticks can carry other infectious bacteria; in fact it is estimated that as many as 40% of patients infected with Lyme may also have other infections transmitted by the same tick. This can complicate the diagnosis of Lyme disease.

Patients can present to a doctor with a myriad of symptoms. Most often patients complain of joint pain but other symptoms include fatigue, shooting pains, numbness and tingling, signs of fibromyalgia, memory loss and emotional changes. Eye findings are not a common presenting symptom. However, Bell's palsy, or “facial nerve palsy” is the most common eye finding. This presents as a motor weakness of the facial muscles on one half of the face. Patients cannot close their eye on that side and severe dry eye may develop. As many as 25% of new-onset Bell's palsy cases may be caused by Lyme disease. Other eye findings include; red eye (conjunctivitis or keratitis), uveitis (inflammation inside the eye), vision loss, optic nerve inflammation and inflammation of the retina (neuroretinitis).

If a patient presents to a doctor with a history of the “bull's eye ring,” a tick on the skin and joint problems the diagnosis can usually be made without difficulty. If the tick is removed within 72 hours and antibiotics are given promptly, the Lyme infection is likely avoided. Lab studies are not typically positive unless the infection has been present for several weeks. Late in the disease, the diagnosis may be difficult, especially if there is no history of a tick bite and no history of a rash. For this reason Lyme disease is often referred to as a “masquerade syndrome” since it can present with so many variable symptoms. Long-term antibiotic therapy may be necessary for patients who are diagnosed late in the disease.

Prevention may be the best treatment. For those who live in endemic areas (Maryland is such an area) one should be cautious in the woods and even the back yard. Wear long sleeve shirts, a hat, long trousers (preferably ticked in the socks) and gloves if doing yard work. Check your pets periodically for ticks and remove them. If you see a tick on your skin and develop a rash at the site after removal, get to your physician as soon as possible for evaluation and treatment.

Springtime is the season for deer. Beware.

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