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Ocular manifestations of Lyme disease.

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Abstract

Although ocular manifestations of
Lyme disease have long been noted, they remain a rare feature of the
disease. The spirochete invades the eye early and remains dormant, accounting for both early and late ocular manifestations. A nonspecific follicular conjunctivitis occurs in approximately 10% of patients with early
Lyme disease. Keratitis occurs often within a few months of onset of
disease and is characterized by nummular nonstaining opacities. Inflammatory syndromes, such as vitritis and uveitis, have been reported; in some cases, a vitreous tap is required for diagnosis. Neuro-ophthalmic manifestations include neuroretinitis, involvement of multiple cranial nerves, optic atrophy, and disc edema. Seventh nerve paresis can lead to neurotrophic keratitis. In endemic areas,
Lyme disease may be responsible for approximately 25% of new-onset Bell’s palsy. Criteria for establishing that eye findings can be attributed to
Lyme disease include the lack of evidence of other
disease, other clinical findings consistent with
Lyme disease, occurrence in patients living in an endemic area, positive serology, and, in most cases, response to treatment. Management of ocular manifestations often requires intravenous therapy.

Am J Med. 1995 Apr 24;98(4A):60S-62S. Review

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