The eye and tick-borne disease in the United States

Sathiamoorthi, Saraniya; Smith, Wendy M.




Purpose of review:Tick-borne diseases are increasing in incidence and geographic distribution. Several diseases endemic to the United States have ophthalmic manifestations, including the most common tick-borne disease, Lyme borreliosis. As ocular complaints may lead a patient to seek medical evaluation, it is important to be aware of the systemic and ophthalmic manifestations of tick-borne diseases in order to make the correct diagnosis.

Recent findings:Vision-threatening ophthalmic manifestations are relatively common in Lyme disease and Rocky Mountain spotted fever. Ocular involvement is rare in babesiosis, tick-borne relapsing fever, Powassan encephalitis, ehrlichiosis, anaplasmosis, and Colorado tick fever.There are clear guidelines for diagnosis and treatment of Lyme disease; however, confusion and misinformation among the general public as well as controversy about chronic or late-stage Lyme disease can impact the evaluation of ophthalmic disease. Furthermore, there are many gaps in our knowledge regarding the pathophysiology of ocular borreliosis although it seems likely that Lyme uveitis is rare in the United States.

Summary:Knowledge of systemic and ophthalmic manifestations combined with an understanding of the epidemiology of disease vectors is crucial for the diagnosis of tick-borne diseases.

Interesting observations have been made by Dr Daniel Cameron in his all things Lyme blog


The authors described patients with tick-transmitted diseases presenting with the following ophthalmologic findings:


  1. Follicular conjunctivitis
  2. Periorbital edema and mild photophobia
  3. Bell’s palsy, cranial nerve palsies and Horner syndrome
  4. Argyll Robertson pupil
  5. Keratitis
  6. Optic neuritis, papilledema, papillitis and neuroretinitis
  7. Myositis of extraocular muscles and dacryoadenitis
  8. Episcleritis, anterior and posterior scleritis
  9. Anterior, intermediate, posterior and panuveitis
  10. Retinal vasculitis, cotton wool spots and choroiditis
  11. Retinitis, macular edema and endophthalmitis 
 The true incidence of ocular findings, however, remains unknown. According to Sathiamoorthi, one case of seronegative uveitis was discredited. “At least one of the earlier case reports of Lyme uveitis found spirochetes in vitreous material, yet serological testing was negative for Lyme antibodies.”

The authors conclude the “degree and frequency of ocular signs and symptoms varies widely between the different [tick-borne] diseases. …The ophthalmologist needs to be alert to the possibility of an infectious cause depending on the patient’s risk factors. The growing number of Lyme disease cases and other tick-borne diseases…should heighten clinical suspicion for tick-borne illness…”

To read Dr Cameron full article go to:-

Dr Cameron was one of the presenters at the first Vis -a -Vis Symposium and his presentation can be found:-

other references for Ocular manifestations of Lyme Disease:-