Lyme disease in eyes

Lyme disease affects multiple body systems, including the eyes. The condition arises from the Borrelia burgdorferi bacteria contracted through a bite from an infected tick. Eye symptoms of Lyme disease include floaters, inflammation and vision changes.

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Lyme disease rash around eyes

One of the early telltale signs of Lyme disease is a bull’s eye target mark on the body at the site of a tick bite. This mark, called erythema migrans, appears in 70%-80% of cases (Source: StatPearls). As Lyme disease spreads to other parts of the body, it can cause a rash in the affected areas, including around the eyes.

There are ways to distinguish a Lyme disease eye rash from another eye infection:

The rash is not itchy
The area is warm to touch
You may also experience flu-like symptoms, like joint pain, fever and enlarged lymph nodes
You have had a recent tick bite

Lyme disease eye problems

Lyme disease gets its name from Lyme, the Connecticut town where it was first discovered. Further observations showed that disease typically moves through three stages (Source: StatPearls).

Stage 1 - local: within 28 days of the tick bite. Symptoms include bull’s eye rash, fever and watery or red eyes.
Stage 2 - disseminated: 3-12 weeks following infection. Symptoms include fever, headache, dizziness, muscle pain, palpitations, eye pain and keratitis (swelling of the cornea).
Stage 3 – persistent/late disseminated: months or years after infection. Common symptoms include arthritis, Bell’s palsy, heart problems and neurological symptoms.

Lyme disease can cause eye problems at any stage. However, the longer the delay in treatment, the more likely you will develop eye problems, like uveitis, photophobia (light sensitivity) and conjunctivitis.

Lyme disease eye symptoms

Many people with diagnosed Lyme disease (borreliosis) don’t recall being bitten by a tick, so it’s helpful to know the symptoms so you can see your doctor if you’re concerned.

Signs of Lyme disease in eyes to look out for:

Lyme disease and optic neuritis

Optic neuritis is a rare complication of Lyme disease where the optic nerve becomes inflamed, leading to severe eye pain and vision loss. An inflamed optic nerve cannot function effectively, so vision is impaired. It’s unclear exactly how Lyme disease causes optic neuritis (Sources: BMJ, WMJ). It could be that the body’s immune system causes the inflammation rather than the Lyme disease spirochaete itself.

Optic neuritis can indicate multiple sclerosis, and this common link sometimes prevents or delays a borreliosis diagnosis. If you think you could have Lyme disease, inform your doctor or optometrist and get a diagnostic blood test as soon as possible.

Can Lyme disease affect vision?

Lyme disease can directly affect vision, typically in the late stages of the disease. Visual changes can include floaters, blurry vision, eye flashes and double vision. In many cases, vision loss is temporary and improves or resolves with treatment of the underlying disease. If you experience vision loss or eyesight changes, see your GP or optometrist as soon as possible.

Frequently asked questions

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.
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.

Conclusion

With early diagnosis and treatment of Lyme disease, long-term eye health effects are minimal. If you have Lyme disease symptoms or become unwell after being bitten by a tick, see your GP.

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Medically reviewed by: The Royal College of Ophthalmologists on 28/07/2022

Edited by: Nick Astbury FRCS FRCOphth FRCP
Clinical Associate Professor
LSHTM

The Royal College of Ophthalmologists champions excellence in the practice of ophthalmology and is the only professional membership body for medically qualified ophthalmologists. The RCOphth is unable to offer direct advice to patients. If you’re concerned about the health of your eyes, you should seek medical advice from your GP, optometrist or ophthalmologist.