Archive for the ‘Eye Issues’ Category

Cast Reports: Orbital Myositis Due to Lyme Disease



In their article “Two Cases of Orbital Myositis as a Rare Feature of Lyme Borreliosis,” Sauer et al. describe two female patients with focal orbital myositis due to Lyme disease. [1]

Orbital myositis is typically caused by systemic disease, such as Grave’s disease, or haematological disorders like lymphomas, the authors explain. In these cases, myositis is often bilateral. It has been reported, as well, as a rare manifestation of Lyme disease.

In these two cases, myositis was confirmed by MRI findings.

Patient #1: 68-year-old female

“The 68-year-old patient had acute and recurrent episodes (lasting from 2 to 4 weeks, 2 to 4 times each year) of right orbital swelling and pain,” the authors wrote.

Each episode resolved spontaneously or with steroids and nonsteroidal anti-inflammatory drugs.

Lyme disease was suspected since the patient was living in a rural area of France, highly endemic for Lyme disease, and she recalled having numerous tick bites and had a history of an erythema migrans rash and arthralgia.

Testing for Lyme disease was positive and the woman began treatment with doxycycline. Within 3 weeks, her symptoms had resolved.

“We reported the cases of two patients who presented with orbital myositis caused by Borrelia infection.”

Patient #2: 13-year-old female

The 13-year-old adolescent complained about unilateral orbital swelling complicated with exophthalmia and horizontal diplopia.

“MRI showed a hyperintense signal of right inferior and medial rectus muscles,” the authors wrote.

The woman was living in an area endemic for Lyme disease and had a recent tick bite followed by an Erythema migrans rash.

Lyme disease testing was positive and she was treated successfully with 4 weeks of doxycycline.

The authors reported, “a resolution of ocular symptoms and a decrease of the MRI signal intensity were observed within 1 month.”

The authors conclude:

  • “Orbital myositis is an unusual manifestation of Lyme disease, although it is likely that the condition is underdiagnosed.”
  • Unexplained muscle swelling occurring in a patient who has had a rash or a recent history of a tick bite in an endemic area for Lyme disease should prompt consideration of this diagnosis.”
  1. Sauer A, Speeg-Schatz C, Hansmann Y. Two cases of orbital myositis as a rare feature of lyme borreliosis. Case Rep Infect Dis. 2011;2011:372470. doi: 10.1155/2011/372470. Epub 2011 Jul 28. PMID: 22567470; PMCID: PMC3336248.



Where to even begin……

  1. Rarely reported is a far different matter than rarely occurs.  Everything about Lyme/MSIDS is downplayed. This most probably happens a lot.
  2. I hesitate to ponder what would have occurred if they hadn’t each tested positive, which is akin to winning the lottery with tests that miss 70% and in this case, 86% of cases.  Current 2-tiered CDC testing also completely omits testing for any coinfections which are quite common.
  3. The second patient had a tick-bite followed by the bullseye rash.  This proves she is infected with Lyme.  No testing required since the rash is diagnostic for Lyme – yet ‘the powers that be’ continue to take the deadly “wait and see” approach and continue to utilize faulty, inadequate testing for diagnosis and treatment.  It seems nothing ever changes.
  4. They continue to treat infected patients with the inadequate and limited mono-therapy of doxycycline, despite research and reality proving this doesn’t work.
  5. Like all other studies, these patients need lengthy follow-up.  IF that occurred, I guarantee that research would prove the current therapy simply doesn’t work.

For more on eye issues with Lyme/MSIDS:

Lyme Can Interfere With How Your Eyes & Brain Work Together

Lyme can interfere with how your eyes and brain work together

April 6, 2023

By William V. Padula, OD SFNAP FAAO FNORA

Tick-borne infections can affect your vision in many ways. There may be blurring, double vision, light sensitivity, visual distortion, difficulty with balance, dizziness, and problems focusing, to name several.

Vision is more than just the image that we see. 70% of all the sensory nerves in the entire body come from the eyes. In fact, the eyes don’t actually see. Rather, they are sophisticated ‘cameras’ through which the brain does the seeing.

The brain has two primary means for organizing visual information. One process (the focal process) is the conscious or attentional process. This part of our vision provides information about detail so that we can see to identify objects. We link our thinking or cognitive process to this portion of vision.

However, there is a second process called the spatial or ambient process. It sets up the ability to use the focal process. The spatial visual process matches information with the balance centers and sends information to the cortex to organize how we see space before we actually see the detail.

The focal process isolates on details. Using the analogy of the forest and the trees, the focal process sees the ‘trees’ and the spatial visual process sees the world as the ‘forest.’ Together the spatial process gives orientation and organization to stabilize the visual process first with proprioception (information from the muscles and joints) establishing a grounding or stability with gravity to engage the spatial visual process first before looking at the detail.

The spatial visual process grounds the visual process and cortex so that the focal process can disassociate to look at a detail without losing orientation to our position sense. When the spatial process becomes unstable, the visual world becomes detail oriented (suddenly the visual world sees only the ’trees’) and this becomes over-whelming, similar to driving in a snowstorm at night with your high beam headlights on.

Maintaining the balance

There is a balance between the two visual processes that must be maintained. This balance provides efficiency, accuracy and the ability to adapt to change in our visual as well as sensorimotor world. (Sensorimotor refers to how we use our senses to interact with our surroundings.)

Lyme-related diseases often produce inflammation, which can disrupt the balance between the two visual processes. Because vision is connected neurologically to respiration and cardio function through the autonomic nervous system, any changes with the visual process will affect the autonomic system.

The imbalance in the visual process produces stress and affects the cardio-rhythms and respiration. A tick-borne infection that becomes neurological will not only directly affect the brain processing associated with visual processing, but may also affect the soft tissue and joints, cardio-respiratory systems, the vestibular system, etc. In turn the neurological imbalance affects both the visual process in the brain directly as well as the indirect relationships with other motor and sensory systems.


One way of evaluating how the eyes and brain work together is called a visual evoked potential (VEP) test. It measures the electrical signal that the brain’s visual cortex generates in response to visual stimulation. Research shows that abnormal results on this test strongly indicate tick-borne disease.

My colleagues and I have also found another potential eye-related biomarker for tick-borne infections—a hazy white ring surrounding the optic nerve. This is called peri-papillary ischemia, and it is highly associated with tick-borne infections. We believe it arises from biofilms that clog the narrow capillary vessels around the optic nerve, blocking blood flow.

In my practice, I have found that changes in the VEP brain waves can be brought back to normal through use of special lenses and various therapeutic techniques. This therapy helps the brain reset how it processes information and resolves many of the patient’s visual challenges. This indicates that VEP abnormalities don’t have to be permanent.

Balance and Movement

The balance difficulties associated with tick-borne disease often come from a mismatch of information between the spatial visual process and other balance centers. This produces a condition know as Visual Midline Shift Syndrome (VMSS).

When there is a mismatch of visual spatial information and information from muscles, joints and the vestibular, the visual midline can become shifted. When this occurs, persons will drift when walking or feel as if they are not as stable. For example, people with this visual spatial imbalance often feel that they are too close to one side of the road when driving. Or they may feel like they are being pulled to one side when walking.

VMSS can be improved by the use of special glasses called “yoked prisms.” These realign the visual midline and re-center the center of mass. Balance can in many cases be improved very quickly when these prisms are prescribed properly.

A Part of the Solution: Rehabilitation of Vision

The following checklist provides a self-assessment for potential symptoms associated with visual processing that may be affected by tick-borne disease.

  • Difficulty converging the eyes to maintain alignment for reading ____
  • Difficulty maintaining focus of the eyes for near vision activities ____
  • Losing place when reading  ____
  • Blurry vision that changes  ____
  • Dizziness ____
  • Difficulty with attention and concentration ____
  • Loss of comprehension when reading  ____
  • Difficulty with visual memory  ____
  • Avoids looking at objects close to the face  ____
  • Difficulty with balance when walking  ____
  • Drifting when walking ____
  • Experiences feeling of being overwhelmed when in busy, crowded environmen____
  • Bumps into objects ____
  • Light and glare sensitive ____

If you are experiencing any of these symptoms, you need a careful assessment of your neuro-visual process. There are some neuro-optometrists who specialize in working with persons with tick-borne infections.

The treatment approach will differ from a standard vision exam. It will include brain wave testing (VEP) and a careful assessment of the neuro-visual-postural organization through instruments to assess weight shift during walking and shift in visual midline/center of mass (COM).

This testing should be accomplished in conjunction with the physician treating the tick-borne infection and not in place of it. Services from psychologists for counseling and/or neuropsychological testing may also be important. Persons with tick-borne infections will need an inter-professional approach for treatment. When the visual process becomes compromised, the problem often continues even after the tick-borne infection has been treated and resolved.

Dr. William Padula is the founder of the Padula Institute of Vision Rehabilitation, in Guilford, Connecticut. More information at his website:



Advances like this are always encouraging; however, it’s important to remember that oftentimes proper treatment will ameliorate symptoms entirely or will at least improve them vastly.  That said, we need all the tools in our toolbox we can get!

For more:

And again, these things are not rare.  They are rarely reported.  Big Diff!

Optic Neuritis Associated With Lyme Disease

Optic neuritis associated with Lyme disease


In their article, “Characteristics of Lyme optic neuritis: a case report of Lyme associated bilateral optic neuritis and systematic review of the literature,” Lu et al. present a rare case of isolated bilateral optic neuritis in a Lyme disease patient. [1] (Optic neuritis is an inflammation of the eye’s optic nerve.)

The case features a 48-year-old female with multiple sclerosis (MS) who presented to her primary care physician with a fever and sore throat.

Three weeks later, she returned complaining of photophobia, eye pressure sensation, blurry vision, pain with eye movements and central scotoma on the morning prior to her visit. (A scotoma is a blurry or blind spot in your visual field while the surrounding areas appear normal.)

An “MRI along with fundus exam confirmed the diagnosis of bilateral optic neuritis,” the authors write.

Two months prior to her visit, the woman had removed a tick from her leg but did not report any rashes.

Testing for Lyme disease was positive by Western blot.

The woman was hospitalized and treated with intravenous methylprednisolone (1g/day for 3 days) due to the degree of swelling, along with ceftriaxone (2 g/day for 25 days) for Lyme disease.

The “patient returned for follow up 1 week post hospitalization, reported visual symptoms abated and she was back to her previous baseline,” the authors write.

“Clinicians working in the endemic areas should consider Lyme borreliosis in patients presents with bilateral optic nerve head swelling, and painless progressive visual loss.”

In reviewing the literature, Lu and colleagues found 11 patient cases of optic neuritis and Lyme disease.

“In this review, we collected cases that have demonstrated strong evidence of causal relationship of Lyme borreliosis and optic neuritis in attempt to characterize the nature and clinical presentations of optic neuritis involved in Lyme borreliosis…,” the authors write.

The most common symptoms related to optic neuritis included blurry vision (11 cases), headache (7 cases), scotoma (3 cases) and painful ocular movement (3 cases).

“Additionally, there were 4 reported neurological symptoms – paresthesia (3 cases) and ataxia (1 case); 3 reported arthralgia; and 3 reported nonspecifc symptoms – fatigue, weakness, and myalgia,” the authors write.

Only 2 of the 11 patients reported having an erythema migrans (Bull’s-eye) rash, while the majority did not recall having a tick bite.

Moderate vision loss was reported in 8 of the patients.

According to the authors, “The patients all responded well with combination of corticosteroid and antibiotic therapy, or antibiotic therapy alone.”

As the authors point out, typically optic neuritis presents with acute, painful, and unilateral visual loss. However, in these Lyme disease patients, it presented with “bilateral optic nerve head swellings, and painless, moderate (better than 20/200) and progressive visual loss.”

Rehabilitating Your Lyme-Impaired Vision

TOUCHED BY LYME: Rehabilitating your Lyme-impaired vision

March 22, 2022

Dr. William V. Padula is a pioneer in the field of how Lyme and other tick-borne diseases can affect your vision. He’s worked with patients from all over the world. Many of them had no idea that Lyme and TBDs were at the root of their deteriorating eyesight.

Though treating the underlying infections is necessary, he says such treatment alone may not be enough to resolve vision problems. Instead, he finds that many patients need various kinds of visual rehabilitation, as well.

In a recent Zoom conversation, he explained to me that among other things, Lyme disease can cause spatial-visual processing dysfunction. This isn’t a defect of the eye itself. Rather, the issue is that the brain has trouble processing the signals the eyes send to it. It’s a neurological impairment.

Spatial-visual processing dysfunction can result in eyestrain, headaches, light sensitivity, and double vision. “Also, people who have a compromised spatial-visual process can have difficulty in crowded, moving environments,” he says.

As a result, people with this disorder may feel overwhelmed by seeing anything moving in their peripheral vision. Much like people who have suffered concussions, Dr. Padula says, many folks with Lyme find they must strictly avoid busy supermarkets and other congested places.


The spatial process links up to what’s called proprioception—how the brain senses when the body is in an upright position, says Dr. Padula. “A frequent complaint of patients with tick-borne infections is that they feel clumsy—they are bumping into tables and doorways. Some have balance problems or actually fall.

His visual rehabilitation techniques use special lenses and prisms to help the brain “reset” the way it processes information.

According to Dr. Padula, when Lyme and other tick-borne infections disrupt visual processing in children, serious learning disabilities can result. He says identifying and treating the problem as early as possible is essential.

He established the Padula Institute of Vision Rehabilitation in Guilford, Connecticut, about 20 years ago, because he knew of no other place that offered this kind of help for children and adults with these neurological challenges.

“We see people here not just with Lyme dysfunction and infection, but also concussion, traumatic brain injury, Parkinson’s, Friedreich’s ataxia—quite a variety of neurological conditions that affect the visual process.”

Dr. Padula says after they’ve worked with someone at the Institute, he and his staff try to find a practitioner in the patient’s own area to continue the treatment. He also lectures and consults internationally, trying to share his methods with other eye doctors throughout the world.

Floaters and dry eyes

I also asked Dr. Padula about something I hear Lyme patients complain about a lot—floaters and dry eyes. He said this often results from a change in tear film. We have three different layers of tear film in our eyes—water, oily, and mucus. When these protective layers are damaged, floaters and dry eye can result.

He finds that additive-free eye drops and supplementation with bioflavonoids, Vitamin C, zinc and magnesium can help.

In the following YouTube video, Dr. Padula and an associate explain more about how Lyme disease can affect your vision.

More videos and further information available at his website.

Dr. Padula has co-authored a book called Neuro-Visual Processing Rehabilitation, which gives details about his methods.

TOUCHED BY LYME is written by Dorothy Kupcha Leland,’s Vice-president and Director of Communications. She is co-author of When Your Child Has Lyme Disease: A Parent’s Survival Guide. Contact her at

For more:

How Lyme Disease Can Affect Your Vision

TOUCHED BY LYME: How Lyme disease can affect your vision

Aug. 4, 2021

Dr. William Padula is a noted expert on how Lyme and other tick-borne diseases can affect the eyes.

According to his website, the following can all be symptoms of tick-borne illness: blur, visual fatigue, double vision, headaches associated with visual activities, light sensitivity, losing place when reading, seeing words appear to double or become double when reading, and more obscure problems often not associated with vision such as difficulty with balance, spatial orientation, memory, comprehension, feeling of being overwhelmed by being in a busy environment, and sensitivity to sound.

The website notes: “The cause of the visual symptoms is because the tick-borne disease affects visual processing in the brain.”

Recently, Dr. Padula has discovered two eye-related biomarkers for tick-borne infection. (A biomarker is something that can be found by examination or testing that indicates the presence of a particular disease or condition.)

In an article published by Healio, Dr. Padula reports:

“My colleagues and I have demonstrated that the presence of a hazy, white ring of peri-papillary ischemia around the optic nerve — especially in children or adults younger than 60 years who would not be expected to have ischemic changes — is associated with tick-borne infection. One way that spirochetes hide from the immune system is by building up protective biofilms. We believe that these biofilms clog the narrow capillary vessels just around the perimeter of the optic nerve, blocking blood flow.”

Dr. Padula recommends that optometrists and ophthalmologists who observe this condition in patients who also have convergence insufficiency or focusing should rule out the possibility of tick-borne infection.

In the same article, Dr. Padula also discusses something called the Visual Evoked Potential (VEP) test. He says that abnormal results on this test strongly indicate tick-borne disease.

As we in the Lyme community know well, it often takes a long time for people to get properly diagnosed with tick-borne infections. If eye doctors become alert to these biomarkers, that could speed up the process considerably.

Click here to read the article on Healio.

Click here to visit Dr. Padula’s website

TOUCHED BY LYME is written by Dorothy Kupcha Leland,’s Vice-president and Director of Communications. She is co-author of When Your Child Has Lyme Disease: A Parent’s Survival Guide. Contact her at


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