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  • Lyme Disease and Scleritis

    By Lynda Seminara
    Selected by Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, September 2022

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    Lyme disease is a multisystem disorder, and ocular involvement can occur at any stage, but reports of scleritis caused by Lyme disease are sparse. Berkenstock et al. looked at the incidence of scleritis in the Baltimore metropolitan area of the United States, a region where Lyme disease is endemic. During the nine-year study timeline, only nine cases of scleritis were ascribed to Lyme disease, representing a prevalence of .052%. The authors concluded that Lyme disease is not a common cause of scleritis, even in areas where the disease is relatively common.

    For this study, the authors gathered data from electronic health records of patients who visited the Wilmer Eye Institute from 2012 through 2020 and had a diagnosis of Lyme disease according to 2020 joint criteria of the Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology. After identifying all new-onset cases of scleritis from the database, they calculated the proportion of new-onset scleritis concurrent with Lyme disease using data from the Baltimore area that had been reported to the CDC. They queried other major academic eye centers in the area to capture any other cases of scleritis related to Lyme disease, then calculated the incidence of this condition using U.S. Census data. In addition, they looked at the clinical features of Lyme-related scleritis.

    Among 980 cases of scleritis report­ed during the study period, only six (.6%) were caused by Lyme disease. One additional case was identified in 2021. The query of other eye facilities did not yield any other cases. The estimated annual incidence of scleritis caused by Lyme disease was .2 per 1,000,000 population in the Baltimore area, and the incidence of Lyme disease in the area was three per 10,000 popula­tion per year. All cases of Lyme-related scleritis were anterior, unilat­eral, and resolved with antibiotic use (without relapse) in a median of 39.5 days (range, 29-57 days). No case was necrotic. Scleritis occurred in only .052% of patients with Lyme disease. Other features of Lyme disease were documented for four patients: a history of erythema migrans in two, cardio­vascular disease in one, and arthritis in another. Other than residing in an endemic area, no demographic factors were consistent among the affected individuals.

    Even though scleritis is a rare man­ifestation of Lyme disease, physicians should be aware of the possible connec­tion, said the authors, particularly as the prevalence of Lyme disease grows. Of note, scleritis may be the sole clini­cal sign of the disease in some patients.

    The original article can be found here.