Lyme disease causes problems with vision

In their article “Lyme Disease and Papilledema: A Retrospective Study on Clinical Characteristics and Outcomes,” Vithayathil and colleagues, describe findings from a retrospective study involving 44 children who presented with vision complications and were later diagnosed with papilledema and Lyme disease.

“Papilledema (optic disc swelling) secondary to intracranial hypertension (IH) has been reported in 6 – 7% of children with neurologic manifestations of Lyme disease,” the authors state. “While there have been multiple large studies examining Lyme meningitis in the children, previous data on papilledema and Lyme disease are limited.”

Vision problems and other symptoms triggered by Lyme disease

The children, ages 1 -18, were treated at the Children’s Hospital of Philadelphia between 1995 – 2019. They were considered positive for Lyme disease if the Western blot met CDC criteria.

“Overall, the median age at presentation was 9.8 years,” the authors state. Most of the children’s symptoms developed over the summer months.

The most common symptoms included headache (68%), diplopia (double-vision) (57%), and nausea/vomiting (48%).

In 95% of the cases, papilledema was bilateral – impacting both eyes.

Meanwhile, 66% of the children “had at least one additional cranial nerve neuropathy, the most common of which was an abducens (sixth) nerve palsy in 24 (55%),” the authors state.

On average, patients sought treatment 20 days after their symptoms began.

Treatment for Lyme-induced vision complications

Oral antibiotics were prescribed in 39% of patients for a median of 14 days, while 55% received IV antibiotics for a median of 18 days. Patients received either doxycycline, amoxicillin, cefuroxime or IV ceftriaxone.

Out of the 35 children with documented follow up, 86% had completely recovered.

“While the pathophysiology of this phenomenon is not completely understood, most affected children recover, regardless of route of antibiotic administration or the presence of pleocytosis,” the authors state. “However, a small proportion do have residual neuro-ophthalmic deficits.”

The authors point out:

• “Papilledema in Lyme disease may occur with or without CSF pleocytosis.”
• “Papilledema was generally the last sign to recover.”

Young boy with blurred vision due to Lyme disease

In another case, a 10-year-old boy with Lyme disease developed problems with his vision, which included sharp, bilateral eye pain, blurred vision and redness over a 3-day period. His symptoms began after he vacationed in a Lyme-endemic region.

The boy’s symptoms completely resolved following treatment with a 2-month course of doxycycline and a prednisone taper.

The authors point out, it is important for clinicians to consider Lyme disease in patients with uveitis if there is a history of recent travel to Lyme-endemic areas.