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Volume 32, Number 1—January 2026

CME ACTIVITY - Synopsis

Retrospective Case Series of Ocular Lyme Disease, 1988–2025

Jenna Bellafiore, Abdallah Mahrous, Vaishnavi Gurumurthy, Eugene Capitle, and Steven E. SchutzerComments to Author 
Author affiliation: Rutgers New Jersey Medical School, Newark, New Jersey, USA (J. Bellafiore, V. Gurumurthy, E. Capitle, S.E. Schutzer); Weill Cornell Medical College, New York, New York, USA (A. Mahrous)

Main Article

Table

Published case reports of ocular Lyme disease that indicate microbiologic proof of Lyme disease, 1988–2025*

Article authors Year† Evidence Age/sex Ocular manifestations, diagnosis, and additional symptoms Treatment and resolution time in article
Dietrich et al. (10)
 2008
 Corneal specimen: spirochete-like bodies and fragments detected by light and electron-microscopic examination. PCR: positive for Borrelia burgdorferi sensu lato DNA. IFA: borderline. Western blot: weak reaction.
 67/M
 History of recurrent iridocyclitis and arthritis (unknown etiology) treated with methotrexate and steroids; developed progressive asymmetric keratopathy
 Penetrating keratoplasty 2 times. IV ceftriaxone for 2 wks, and systemic immunosuppression (prednisone and methotrexate) continued. Tetracycline eyedrops and steroid eyedrops continued for >2 y without recurrence.
Hilton et al. (11)
 1996
 Vitreous fluid: positive PCR test result for 232-bp segment specific for B. burgdorferi; ELISA-negative (repeat test 4 mo later positive); Western blot negative, with faint reactivity to 4 IgG bands (repeat test 4 mo later positive).
 26/F
 Diagnosed with pars planitis
 Doxycycline 100 mg 2×/d with improvement but recurrence. Treated with IV ceftriaxone 2 g/d for 10 d, followed by 2 mo oral macrolides. Visual deterioration requiring vitrectomy.
Kauffmann and Wormser (12)
 1990
 IFA: positive IgM and IgG. Vitreous debris examination showed occasional intact spirochetes compatible with Lyme disease. FTA-ABS and VRDL negative for Treponema pallidum.
 45/F
 Painful red eye with decreased vision and periorbital edema; diagnosed with iritis and posterior synechiae; additional symptoms: headache, lightheadedness, fevers, nausea, vomiting, EM-like rash
 Prior treatment with steroids with development of sudden rise in ocular pressure with proptosis, conjunctival purulent discharge, and rapid-onset dense cataract. Started on nafcillin and gentamicin for possible orbital cellulitis. Without improvement, had vitrectomy 2 times.
Sauer et al. (13)
 2009
 ELISA: positive. Western blot: positive; aqueous humor: Borrelia spp. DNA noted.
 39/F
 Acute diplopia, pain and redness; diagnosed with abducens nerve palsy and anterior uveitis; additional symptoms: EM and arthralgia
 Ceftriaxone 2 g/d for 2 wks and topical steroids with recovery.
Hardon et al. (14) 2002 ELISA-positive for IgG. CSF PCR positive for Borrelia spp. CSF antibody: negative. 31/M Reduced eye movements; diagnosed with bilateral internuclear ophthalmoplegia IV ceftriaxone 2 g/d for 3 wks with resolution.

*As of March 15, 2025. Year listed is the year of publication unless the year of the case is otherwise specified in the cited article. Not all cases were based on current Centers for Disease Control and Prevention case definition. CSF, cerebrospinal fluid; EM, erythema migrans; FTA-ABS, fluorescent treponemal antibody absorption test; IFA, indirect immunofluorescence assay; IV, intravenous; VDRL, Venereal Disease Research Laboratory test.

Main Article

References
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