Lyme disease is caused by the spirochete Borrelia burgdorferi, which is transmitted to humans by ticks from animal reservoirs: primarily rodents, deer, birds, cats, and dogs. Early systemic manifestations consist of myalgias, arthralgias, fever, headache, malaise, and a characteristic skin lesion known as erythema migrans or a bull’s-eye rash, which consists of an annulus of erythema surrounding an area of central clearing. In later stages, as neurologic or musculoskeletal findings manifest, ocular inflammation may develop but is uncommon. Lyme disease–related ocular findings include keratitis, scleritis, and uveitis, which may include anterior chamber or vitritis inflammation, retinal vasculitis, papillitis, or optic neuritis. Chronic uveitis in patients who reside in or have traveled to an endemic area or who have had a recent tick bite or an erythema migrans–like skin lesion should suggest the possibility of Lyme disease. Initial serologic testing is performed using a sensitive ELISA. If an ELISA result is positive or equivocal, then separate IgM immunoblotting (if symptoms have been present for fewer than 30 days) and IgG immunoblotting should be performed on the same blood sample. A diagnosis of Lyme disease is supported only when both tests are positive. The 2 tests are designed to be used together; thus, the initial ELISA test should not be skipped. Treatment for early disease consists of tetracycline, doxycycline, or penicillin. Advanced disease may require intravenous ceftriaxone or penicillin.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.