Table 10-2 lists treatment recommendations for the various clinical manifestations of LD. For patients with ocular involvement, the route and duration of antibiotic treatment have not been established; however, as with syphilitic uveitis, intraocular inflammation associated with LD is best regarded as a manifestation of CNS involvement and warrants careful neurologic evaluation, including a lumbar puncture. Patients with severe posterior segment manifestations—and certainly those with confirmed CNS involvement—require intravenous antibiotic therapy with neurologic dosing regimens. Likewise, patients with less-severe disease that responds incompletely or relapses when oral antibiotics are discontinued should probably be treated with intravenous drugs as outlined in Table 10-2. Patients with Lyme carditis or who have atrioventricular block should be admitted to the hospital, monitored, and administered treatment with intravenous antibiotics.
After the initiation of appropriate antibiotic therapy, anterior segment inflammation may be treated with topical corticosteroids and mydriatics. The use of systemic corticosteroids has been described as part of the management of LD; however, the routine use of corticosteroids is controversial, as it has been associated with an increase in antibiotic treatment failures. As with syphilis, the Jarisch-Herxheimer reaction may complicate antibiotic therapy. Patients may become reinfected with B burgdorferi after successful antibiotic therapy, especially in endemic areas, or they may experience a more severe or chronic course due to concomitant babesiosis (an intraerythrocytic parasitic infection caused by protozoa of the genus Babesia, which is also transmitted by Ixodes species ticks) or human granulocytic anaplasmosis (previously known as human granulocytic ehrlichiosis) and require retreatment with antibiotics. Prevention strategies include avoiding tick-infested habitats, using tick repellents, wearing protective outer garments, removing ticks promptly, and reducing tick populations.
Mikkila E, Smith C, Sood S. The expanding clinical spectrum of ocular Lyme borreliosis. Ophthalmology. 2000;107(3):581–587.
Sathiamoorthi S, Smith WM. The eye and tick-borne disease in the United States. Curr Opin Ophthalmol. 2016;27(6):530–537.
Table 10-2 Recommended Antimicrobial Regimens for Treatment of Lyme Disease
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.