Pinky Jha, MD, MPH; Sophie G Rodrigues Pereira, BS; Abhishek Thakur, BS; Gurdeep Jhaj, MD; Sanjay Bhandari, MD

Optic neuritis is a condition associated with various systemic diseases, such as multiple sclerosis, and is also considered a rare complication of Lyme disease.
A 46-year-old white woman presented with sudden onset of bilateral vision loss. After extensive workup, she was diagnosed with Lyme optic neuritis based on the clinical presentation and positive serology. She was treated with doxycycline for 2 weeks.
Lyme disease is caused by infection with the spirochete Borrelia burgdorferi. The most commonly affected areas include the skin, joints, heart, and nervous system. Lyme optic neuritis is a challenging diagnosis and therefore often underreported. Doxycycline or ceftriaxone for 2 weeks are recommended for treatment.
We report this case to increase awareness among clinicians to include Lyme disease in the differential diagnosis of optic neuritis for unexplained cases of vision loss, particularly in Lyme endemic areas.
Here we see another study stating a Lyme symptom (optic neuritis) is rare but at least has the integrity to state it is often underreported and for clinicians to include it when confronted with a case of unexplained vision loss.  Please know that when researchers boldly claim something is rare, it automatically has the ability to cause clinicians to not even consider it.  
A more honest statement would be:  Although optic neuritis is rarely found in the literature, it is often underreported with the true number of cases unknown.
I’m also thankful more researchers are publishing case reports because frankly, it’s the only way the truth is going to get into the literature.  If enough case reports pop up it will no longer be considered rare.
Also, the 2 weeks of doxy/ceftriaxone is based on outdated CDC Lyme guidelines that are not considering numerous factors including but not limited to coinfections with other tick borne pathogens as well as the fact many patients have persistent symptoms that need addressing.  Until these issues are dealt with, patients are doomed.
If there’s one thing I’ve learned on this journey from hell, it’s that tick borne illnesses rarely fit into a nice, neat little box such as this study.  This poor woman could very well have numerous symptoms besides optic neuritis but these researchers aren’t going to connect the dots which is why we must educate ourselves, our loved ones, and frankly, anyone who will listen.  Familiarize yourself with symptoms of not only Lyme but of the various coinfections.
Bartonella, a coinfection, commonly affects the eyes.  Authorities are still squabbling over whether ticks can transmit it but in my experience it is common with Lyme/MSIDS patients so it’s either being directly transmitted or a latent infection is reactivating upon a tick bite:
Even though there may be a lack of systemic signs and symptoms of CSD in a patient with neuroretinitis, B henselae infection should be considered.
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