Episcleritis, conjunctivitis, and keratitis as ocular manifestations of Lyme disease

A 35-year-old woman presented with a bilateral palpebral follicular conjunctivitis. Subsequently, she developed a bilateral keratitis and, on a separate occasion, an episcleritis that was associated with a recrudescence of Lyme disease and poor compliance with the antibiotic regimen. Both the keratitis and episcleritis cleared completely after topical corticosteroid therapy and reinstitution of appropriate antibiotic treatment. This report emphasizes the importance of collaboration between internal medicine and ophthalmologic specialists during the long-term management of Lyme disease.     

Lyme disease: neurologic and ophthalmic manifestations

Lyme disease is tick-borne infection which produces early and late manifestations in many organ systems. Prominent symptoms and signs occur in skin, heart, joints and nervous system. Many ocular and neuro-ophthalmic abnormalities recently have been attributed to Lyme disease, but some cases have not been well established as direct sequelae. This review of the contemporary state of knowledge about Lyme disease was undertaken so that more rigorous criteria can be applied in future diagnosis.     

Ocular manifestations of Lyme disease

The incidence of Lyme disease has been increasing at alarming rates in recent years. Being the most commonly reported tickborne bacterial disease in the United States, it now outnumbers Rocky Mountain spotted fever by a ratio of almost 2:1. It is a multisystem illness and can manifest itself with dermatologic, neurologic, cardiac and rheumatologic involvement. The ocular complications of Lyme disease can present as one of the more ominous signs during the course of the illness. The detection of the disease and proper referral by the optometrist may permit more appropriate treatment, and thus, a better prognosis of the illness.     

Neuro-ophthalmologic manifestations of Lyme disease

Lyme disease is a tick-borne spirochetal infection characterized by skin rash, neurologic, cardiac, and arthritic findings. The authors report six patients with Lyme disease who had neuro-ophthalmologic manifestations. One patient had meningitis with papilledema, two had optic neuritis, and one had neuroretinitis. Three patients had sixth nerve paresis, two of whom cleared quickly, whereas multiple cranial nerve palsies and subsequent optic neuropathy developed in another. Early recognition of neuro-ophthalmologic findings can help in the diagnosis and treatment of Lyme disease.     

Lyme disease in Switzerland: ocular involvement]

Lyme disease is a multisystem disorder caused by the spirochete Borrelia burgdorferi, which is transmitted by a tick (Ixodes Ricinus). Lyme disease is divided into three stages (infection, dissemination and immunological reactions). Ocular manifestations are rare except for conjunctivitis and facial nerve palsy. Switzerland is an endemic zone for Lyme disease; the presence of an atypical pars planitis should prompt a search for Lyme disease.     

Ocular manifestations and treatment of Lyme disease

Ocular manifestations in Lyme disease have been considered rare. In surveys and epidemiologic studies the possibility of ocular Lyme disease has usually not been taken into account. Patients with late ocular. Lyme disease may be seronegative by routine enzyme-linked immunosorbent assays, but immunoblot or detection of Borrelia DNA by polymerase chain reaction may help in diagnosing those cases. An ophthalmologist may suspect the diagnosis of Lyme disease in inflammatory ocular syndromes with unusual biomicroscopic or angiographic findings. Intraocular Lyme disease is usually treated with intravenous ceftriaxone or cefotaxime. Jarisch-Herxheimer reaction may occasionally complicate the antibiotic treatment of ocular manifestations. Overtreatment with ceftriaxone should be avoided because of a possibility of biliary complications.     

莱姆病的眼底表现及其治疗

莱姆病系由硬蜱传播包柔螺旋体所引起的一种全身性疾病,可累及眼部多个部位而致视力丧失。1989年以来收治了51例,88只眼,其眼底表现以视网膜血管炎合并增殖性改变为主。依据病史、检查和血清莱姆病抗体(≥1∶128)作出诊断。3例玻璃体发现螺旋体。采用玻璃体切除术(11只眼)、氩离子激光(27只眼)和先锋霉素V等药物综合治疗,莱姆病抗体阴转率约80％,致盲率45.1％。     

Cat-scratch disease: ocular manifestations and visual outcome

To describe the intra-ocular manifestations of cat-scratch disease (CSD) found at two uveitis reference centers in Brazil. Retrospective case series study. Review of clinical records of patients diagnosed with CSD in the Uveitis Department of São Geraldo Hospital and the Ophthalmology Department of the Instituto de Pesquisa Clínica Evandro Chagas—FIOCRUZ, from 2001 to 2008. In the 8-year period, 24 patients with the diagnosis of CSD were identified. Twelve patients were male and 12 female. The mean age was 27.04 years (range 7–56). Sixteen patients (66.6%) presented with a history of a cat scratch and all patients reported cat exposure. Visual acuity ranged from counting fingers to 1.0 in the affected eye. Thirteen patients presented with bilateral disease. Sixteen (66.6%) patients complained of systemic symptoms, including fever, lymphadenopathy, liver and spleen enlargement and rash. All patients presented with serum antibodies (IgG) to Bartonella henselae. Thirty-seven eyes were affected. The most common findings were small areas of retinal infiltrates which occurred in 11 eyes (29.7%) and angiomatous lesions which occurred in nine eyes (24.3%). Neuroretinitis occurred in only six eyes (16.2%). The most common findings of CSD in our study were retinal infiltrates and angiomatous lesions. CSD patients may present with significant visual loss. Patients may benefit from systemic treatment with antibiotics.     

Diverse ocular manifestations in Boeck disease

The clinical picture of sarcoidosis varies widely; in many cases there are few symptoms. In cases where the initial symptoms of sarcoidosis are ocular the diagnosis can only be established if systemic disease is considered in differential diagnosis. Five cases with ocular manifestation and unusual findings or development are described.     

The ocular manifestations of inflammatory bowel disease

PURPOSE OF REVIEW: The purpose of this review is to present the literature on the ocular complications of inflammatory bowel disease, their pathogenesis, manifestation and treatment options. In particular, the literature pertaining to recently available treatments will be reviewed. RECENT FINDINGS: Although the pathogenesis of inflammatory bowel disease remains incompletely understood, treatment options for ocular and systemic disease have expanded with the introduction of newer steroid-sparing agents such as mycophenolate mofetil and a new class of immunomodulatory agents targeting cytokines, in particular infliximab, a monoclonal antibody directed against tumour necrosis factor-alpha. SUMMARY: That inflammatory bowel disease can have ocular manifestations has been known for over 80 years. Knowing of their occurrence and treatment options enables the treating clinician to recognize their cause and treat them appropriately.     

Linear IgA disease. The ocular manifestations

The ocular history and examination of a 54-year-old Filipino woman with linear IgA disease is described. Results of the eye examination were consistent with chronic cicatricial conjunctivitis, showing subconjunctival fibrosis and symblepharon formation. Direct immunofluorescence of the conjunctiva was positive for IgA and C3 in a linear pattern along the epithelial basement membrane. The ophthalmologic and dermatologic findings in linear IgA disease are compared with those of dermatitis herpetiformis, bullous pemphigoid, and cicatricial pemphigoid. This is the first documented case report of the ocular manifestations of linear IgA disease in the American literature.     

Retinal angiomatosis: the ocular manifestations of von Hippel-Lindau disease

The ocular manifestations of a large von Hippel-Lindau pedigree are presented. Of 24 persons with retinal angiomas, 18 are living and are the basis of this report. Nineteen of their 28 affected eyes were asymptomatic with 2 to 4 small tumours per eye. Nine eyes had lost vision secondary to exudative detachment. Seven of these had peripheral disease with rapid recurrences. Two had untreated disc tumours. Tumours less than 1 disc diameter (DD) in size were easily treated with photocoagulation. Multiple treatments of cryotherapy were required for larger tumours. Scleral buckle and early vitrectomy are recommended for vitreous traction. Tumour in a 4-year-old and a de-novo tumour in a 42-year-old lead us to recommend life-time surveillance of patients at risk. Many patients had false negative family histories. A review of the literature leads us to suspect that the majority of retinal angiomas are familial. We emphasize the ophthalmologist's responsibility to investigate such patients.     

Unusual ocular manifestations in 2 cases of Takayasu's disease

We retrospectively reviewed 2 cases of Takayasu's disease manifesting with unusual eye findings. In a 37-year-old woman, aside from the typical hypoperfusion retinopathy, epiretinal membranes were also observed in both eyes. The occurrence of a branch retinal artery occlusion with development of iris rubeosis as a complication was noted in a 75-year-old woman despite the absence of retinal vessel changes typical of Takayasu's disease. Presented in part at the 5th International Symposium on Ocular Circulation and Neovascularization at Kyoto, Japan, Sept. 15–19, 1997.     

Adamantiades-Behcet disease: diagnosis and current concepts in management of ocular manifestations

Adamantiades-Behcet disease is a relapsing systemic vasculitis that may involve the eyes, skin, and almost all other organ systems. The comprehensive ophthalmologist plays a key role by not only making the diagnosis but also by monitoring inflammatory status to guide systemic therapy. If left untreated, the disease has a high likelihood of causing blindness and death. Adamantiades-Behcet disease with retinal involvement is now considered an absolute indication for systemic immunomodulatory therapy. The diagnostic signs, potential complications, and treatment modalities currently available for ocular Adamantiades-Behcet disease are reviewed.