Correspondence

Ocular Lyme Borreliosis

N Engl J Med 2001; 345:1350-1351November 1, 2001

Article

To the Editor:

The superb review article on Lyme disease by Steere (July 12 issue)1 omitted a manifestation associated with the disease: ocular Lyme borreliosis. Ocular Lyme borreliosis is probably underdiagnosed not only because of difficulties in the serologic diagnosis of the disease, but also because the clinical ocular features are often not recognized.

Uveitis (which may be associated with photophobia, macular edema, retinal vasculitis, and decreased vision), neuroretinitis, and choroiditis with retinal detachment may develop.2 Neuro-ophthalmic manifestations include optic neuropathy and other cranial neuropathies such as abducens-nerve palsy and paresis of the seventh nerve (which may lead to neurotrophic keratopathy) and pseudotumor cerebri. Interstitial keratitis, episcleritis, and follicular conjunctivitis are possible anterior-segment manifestations. Transient worsening of symptoms after the intravenous administration of ceftriaxone as a result of a Jarisch–Herxheimer reaction has also been described.3

These manifestations are important components of the clinical spectrum of Lyme borreliosis. They occasionally develop in the early stages of the disease, but in most cases they are late manifestations. Interestingly, it was Steere and colleagues who first described proven ocular Lyme borreliosis in their 1985 report of a patient who was blinded from severe panophthalmitis and in whose vitreous Borrelia burgdorferi spirochetes were found.4

Michael Colucciello, M.D.
South Jersey Eye Physicians, Moorestown, NJ 08057
retina7@pol.net

4 References

1. 1

   Steere AC. Lyme disease. N Engl J Med 2001;345:115-125
   Full Text | Web of Science | Medline

2. 2

   Karma A, Seppala I, Mikkila H, Kaakkola S, Viljanen M, Tarkkanen A. Diagnosis and clinical characteristics of ocular Lyme borreliosis. Am J Ophthalmol 1995;119:127-135
   Web of Science | Medline

3. 3

   Mikkila HO, Seppala IJ, Viljanen MK, Peltoma MP, Karma A. The expanding clinical spectrum of ocular Lyme borreliosis. Ophthalmology 2000;107:581-587
   CrossRef | Web of Science | Medline

4. 4

   Steere AC, Duray PH, Kauffmann DJ, Wormser GP. Unilateral blindness caused by infection with the Lyme disease spirochete, Borrelia burgdorferi. Ann Intern Med 1985;103:382-384
   Web of Science | Medline

Author/Editor Response

The author replies:

To the Editor: In my original review article on Lyme disease,1 which was published in the Journal 12 years ago, I listed the known clinical manifestations of the infection. With regard to ocular manifestations, the list included reports of conjunctivitis, iritis, choroiditis, retinal hemorrhage or detachment, keratitis, and panophthalmitis. Because of space limitations, I was not able to reiterate this list in the current review.2 Instead, in the section on clinical manifestations and pathogenesis, I presented only the more common clinical manifestations of the infection and reviewed new information about the immunopathogenesis of each of these manifestations, including insights gained from animal models of the infection.

Although I was not able to include information on eye abnormalities or other uncommon manifestations of Lyme disease in my current review, in the section on neurologic involvement I did mention optic neuropathy in children with Lyme disease, citing a recent article.3 This manifestation may result from inflammation of the optic nerve, increased intracranial pressure, or both and may lead to permanent bilateral blindness, a complication that had not yet been reported 12 years ago.

In the current review,2 I stated, “The clinical manifestations of Lyme disease remain basically as they were presented in the Journal 12 years ago.” My hope was that readers who were interested in reviewing the list of clinical manifestations of the infection would refer to the original article.

Allen C. Steere, M.D.
Tufts University School of Medicine, Boston, MA 02111

3 References

1. 1

   Steere AC. Lyme disease. N Engl J Med 1989;321:586-596
   Full Text | Web of Science | Medline

2. 2

   Steere AC. Lyme disease. N Engl J Med 2001;345:115-125
   Full Text | Web of Science | Medline

3. 3

   Rothermel H, Hedges TR III, Steere AC. Optic neuropathy in children with Lyme disease. Pediatrics 2001;108:477-481
   CrossRef | Web of Science | Medline

Citing Articles (2)

Citing Articles

1. 1

   Cornelis Vink, Gloria Rudenko, H. Steven Seifert. (2011) Microbial antigenic variation mediated by homologous DNA recombination. FEMS Microbiology Reviewsn/a-n/a
   CrossRef

2. 2

   B. Kadz, A. Putteman, C. Verougstraete, L. Caspers. (2005) La maladie de Lyme du point de vue de l’ophtalmologue. Journal Français d'Ophtalmologie 28:2, 218-223
   CrossRef