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.
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
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.
Medically reviewed by: The Royal College of Ophthalmologists on 28/07/2022
Edited by: Nick Astbury FRCS FRCOphth FRCP
Clinical Associate Professor
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.