Ocular inflammation can occur in patients with documented Lyme disease and has been reported to involve any part of the eye. Uveitis is uncommon, but case reports and small series demonstrate a wide variety of presentations including iridocyclitis, vitritis, multifocal choroiditis, exudative retinal detachment and panophthalmitis. Although Lyme disease is the most commonly reported tick-borne infection in the United States and Europe, there are unresolved issues related to its diagnosis and management. For early Lyme disease, therapy is clear, but for both late-stage disease and presumed chronic Lyme disease, therapeutic approaches are not as well defined. This article offers a rational approach to treating Lyme disease patients.