Archive for the ‘Eye Issues’ Category

‘Rare’ Case of Optic Neuropathy Caused by Lyme Disease

2020 Feb 7;12(2):e6906. doi: 10.7759/cureus.6906.

A Rare Cause of Optic Neuropathy.


Lyme disease is a multisystem infection caused by Borrelia burgdorferi that mainly affects the joints, the heart, and the nervous system. Neurological complications usually manifest in untreated patients and present as meningitis, cranial neuropathies, and radiculoneuritis. The authors present the case of a 48-year-old male who developed loss of vision in the right eye over a period of two months. On physical examination a relative afferent pupillary defect of the right eye was noted. Visual evoked potential test revealed delayed P100 latency bilaterally, confirming a bilateral optic neuropathy. The analysis of the cerebrospinal fluid (CSF) showed a lymphocytic meningitis. After an extensive work-up, a diagnosis of Lyme neuroborreliosis with meningitis and optic neuritis was made. The patient was treated with antibiotics and showed gradual improvement. The follow-up brain MRI revealed a mild T2 hyperintensity on the right optic nerve with gliosis, sequelae of the inflammatory process.

Lyme disease should always be considered in patients from endemic areas with nonspecific symptoms. The diagnosis of neuroborreliosis is challenging, but prompt identification and treatment can prevent the development of complications and sequelae.



Again, just because there isn’t thousands of cases in the literature – doesn’t mean this is rare.  It’s only rare because so many go undiagnosed and testing misses over half of all patients.  If you type in eye or optic in the search bar on this website, you will quickly determine eye issues with Lyme is not rare at all.

Lyme isn’t the only offender:  Bartonella commonly causes eye issues.

Ocular Complications of Cat Scratch Disease

2020 Mar 2. pii: bjophthalmol-2019-315239. doi: 10.1136/bjophthalmol-2019-315239. [Epub ahead of print]

Ocular complications of cat scratch disease.


Cat scratch disease (CSD) in humans is caused by infection with Bartonella henselae or other Bartonella spp. The name of the disease reflects the fact that patients frequently have a history of contact (often involving bites or scratches) with infected cats. Patients with CSD typically develop lesions at the site where the skin is broken together with regional lymphadenopathy but may go on to exhibit systemic symptoms and with deep-seated infections at a range of sites including the eye. Patients with CSD may present with a range of inflammatory eye conditions, including Parinaud’s oculoglandular syndrome, neuroretinitis, multifocal retinitis, uveitis and retinal artery occlusion. Bartonella spp. are fastidious bacteria that are difficult to culture from clinical specimens so microbiological diagnosis is frequently made on the basis of positive serology for anti-Bartonella antibodies or detection of bacterial DNA by PCR. Due to the lack of clinical trials, the evidence base for optimal management of patients with CSD-associated eye infections (including the role of antibiotics) is weak, being derived from single reports or small, uncontrolled case series.



This study states what the rest of us all know – there is a lack of research on Bartonella yet it is everywhere:

And please know you don’t have to be exposed to cats to get it:

You also don’t have to be immunocompromised to get it:

Infectious Keratitis Caused by Rare and Emerging Micro-Organisms

2019 Dec 23. doi: 10.1080/02713683.2019.1708407. [Epub ahead of print]

Infectious Keratitis Caused by Rare and Emerging Micro-Organisms.


Purpose:  To provide a comprehensive review on rare and emerging micro-organisms causing infectious keratitis.

Material and Methods:  A literature search was performed using PubMed Medline, Cochrane Library Database, EMBASE and Scopus (1960 onwards), using the terms: keratitis caused by rare pathogens; mycotic keratitis; fungal keratitis; bacterial keratitis; infectious keratitis; infective keratitis; atypical fungal keratitis; fungal keratitis caused by rare organisms; fungal keratitis caused by rare ocular pathogen; atypical bacterial keratitis; bacterial keratitis caused by rare organisms; bacterial keratitis caused by rare ocular pathogen. All relevant articles were included in this review.

Results:  A total of 1232 articles matched our search strategy of which 124 articles were included in this mini-review. The rare and emerging bacteria causing keratitis include atypical mycobacteria, Nocardia spp., Chrysebacterium spp., Delftia acidovorans, Kocuria spp., Enterococcus spp., Bartonella henslae, Achromobacter spp. and others. The rare and emerging fungi causing keratitis include Pythium spp., Alternaria spp., Acremonium spp., Cladosporium spp., Curvularia spp., Bipolaris spp., Microsporidia spp., Pseudallescheria spp., Colletotrichum spp., and others. The clinical presentation of these cases is variable. While a few organisms produce characteristic clinical features, rest present similar to bacterial or fungal keratitis with variable response to routine treatment. A strong degree of suspicion is therefore essential for its diagnosis. Special investigations like polymerase chain reaction, gene sequencing, mass spectroscopy and enzyme-linked immunosorbent assay are required for accurate identification of these organisms. Culture-sensitivity is extremely useful as drug resistance to routinely used anti-microbial drugs is common. Prognosis is usually poor for keratitis with Pythium spp., Pseudallescheria spp., Arthrographis spp., Purpureocillium spp., Kociria spp. and Achromobacter spp.

Conclusion:  Keratitis caused by rare and emerging micro-organisms must be suspected in cases where the infection runs an unusual course or shows poor response to standard anti-microbial drugs. Early diagnosis and timely treatment hold the key for good outcome.



Keratitis is inflammation in the cornea.  The following symptoms were found here:


Signs and symptoms of keratitis include:

  • Eye redness
  • Eye pain
  • Excess tears or other discharge from your eye
  • Difficulty opening your eyelid because of pain or irritation
  • Blurred vision
  • Decreased vision
  • Sensitivity to light (photophobia)
  • A feeling that something is in your eye

Great read on Lyme disease also causing keratitis:

And here we see Bartonella affecting cats with keratitis as well as conjunctivitis, uveitis, blepharitis, and chorioretinitis:

For more:



Development & Spontaneous Resolution of a Full-thickness Macular Hole in Bartonella Neuroretinitis

2019 Jul 9;15:100515. doi: 10.1016/j.ajoc.2019.100515. eCollection 2019 Sep.

The development and spontaneous resolution of a full-thickness macular hole in bartonella henselae neuroretinitis in a 12-year-old boy.



To describe an unusual case of Bartonella henselae neuroretinitis complicated by macular hole (MH) development.


A full-thickness macular hole developed in a 12-year-old boy in association with serology-confirmed Bartonella henselae neuroretinitis. Following a period of observation, the MH closed without intervention.


MH may occur as a complication of neuroretinitis secondary to Cat-Scratch Disease.



This great article by Galaxy Labs reveals that Bartonella loves the eyes:



Multimodal Imaging of Two Unconventional Cases of Bartonella Neuroretinitis

2019 Jul 16. doi: 10.1097/ICB.0000000000000893. [Epub ahead of print]




To report two cases of cat-scratch fever with atypical posterior segment manifestations.


Two cases were retrospectively reviewed.


  • A 27-year-old woman presented with painless blurring of central vision in her left eye. Clinical examination revealed a small focal area of retinitis within the macula associated with a subtle macular star. Spectral-domain optical coherence tomography showed a hyper-reflective inner retinal lesion in addition to subretinal and intraretinal fluid as well as hyperreflective foci within the outer plexiform layer. Serology was positive for anti-B. henselae IgM (titer 1:32).
  • A 34-year-old woman presented with painless loss of vision in both eyes associated with headaches and pain with extraocular movement. Spectral-domain optical coherence tomography depicted subretinal fluid, intraretinal fluid, and hyperreflective deposits within the outer plexiform layer. A focal collection of vitreous cell was observed overlying the optic nerve in the left eye. Bilateral disk leakage was identified on fluorescein angiography. Serology revealed high-titer anti-B. henselae antibodies (IgM titers 1:32, IgG titers 1:256).


Our cases highlight the necessity of recognizing more unusual posterior segment presentations of ocular bartonellosis. Multimodal retinal imaging including spectral-domain optical coherence tomography may help better characterize lesions.


For more:  Bartonella, like Lyme, can be persistent causing chronic infection.


Atypical Papillitis: An Isolated Manifestation of Lyme Disease (Which isn’t Isolated)

2019 Jun 5:1120672119855210. doi: 10.1177/1120672119855210. [Epub ahead of print]

Atypical papillitis: An isolated manifestation of Lyme disease.


Lyme disease is a rare condition caused by the bacterium Borrelia burgdorferi. Despite typical symptoms including fever, headache, fatigue, and a characteristic skin rash, sometimes we cannot find those due to the lack of physician consultation in those early stages. If this disease is left untreated, infection could spread to the nervous system causing neuroborreliosis, an atypical and complicated manifestation of this disease. We present the case of an atypical papillitis, probably caused by this bacterium. We suspected this because of the results on the indirect test bloods and the improvement of the symptoms after treatment. This entity should be considered as a possible diagnosis of atypical optical neuropathies, particularly if it occurs in an endemic area.



Lyme disease is NOT A RARE CONDITION.

Neuroborreliosis is NOT ATYPICAL. It is the inevitable outcome without treatment.

Note that they state the “atypical” papillitis is probably due to Lyme and they make that decision based upon a blood test as well as improvement after treatment.

This is a great example of how doctors should be treating Lyme/MSIDS clinically. They also shouldn’t be fearful of treating this clinically. Due to abysmal serology testing, doctors should understand that testing positive is not a prerequisite, but if symptoms add up, they should treat clinically and look at results.  As they say, “the proof’s in the pudding.”

Lyme/MSIDS should be considered in any neuropathy. It is a well known symptom. 

According to the National Eye institute, papillitis is a twenty dollar word for optic nerve inflammation.

Lyme loves the eyes and nerves and causes wide spread inflammation.


  • loss of vision
  • pain in the eye
  • interference with accurate color vision (dyschromatopsia)


  • Diseases that result in damage to the lining of nerves (demyelinating diseases) such as multiple sclerosis and encephalomyelitis; viral or bacterial infections such as polio, measles, pneumonia, or meningitis
  • nutritional or metabolic disorders such as diabetes, pernicious anemia, and hyperthyroidism
  • secondary complications of other diseases
  • reactions to toxic substances such as methanol, quinine, salicylates, and arsenic
  • trauma

Being in an endemic area has NOTHING to do with this.

Ticks are everywhere, and happily transmitting diseases as they travel. These types of limiting statements by ignorant researchers have been used against patients for decades. Doctors desperately need to study this and stop believing and repeating ancient mythology.

For more on Lyme & eye issues:  The authors described patients with tick-transmitted diseases presenting with the following ophthalmologic findings:

  • Follicular conjunctivitis
  • Periorbital edema and mild photophobia
  • Bell’s palsy, cranial nerve palsies and Horner syndrome
  • Argyll Robertson pupil
  • Keratitis
  • Optic neuritis, papilledema, papillitis and neuroretinitis
  • Myositis of extraocular muscles and dacryoadenitis
  • Episcleritis, anterior and posterior scleritis
  • Anterior, intermediate, posterior and panuveitis
  • Retinal vasculitis, cotton wool spots and choroiditis
  • Retinitis, macular edema and endophthalmitis

I sent all of this information to the first author. Hopefully, she will read it.


Retinal Vessel Occlusion Caused by Bartonella Infection

. 2018 Nov 19; 33(47): e297.
Published online 2018 Oct 29. doi: 10.3346/jkms.2018.33.e297
PMCID: PMC6236082
PMID: 31044568

A Case of Retinal Vessel Occlusion Caused by Bartonella Infection

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A 29-year-old female visited the emergency room with sudden visual loss in the right eye started on the same day. She had been suffering from fever for two days. A best-corrected visual acuity (BCVA) was 0.5/0.7 in the Snellen chart. Fundus examination (Fig. 1) showed multiple retinal hemorrhages. Severe vascular sheaths around the optic disc area were present in the right eye. Candle-wax-dripping sign in the superior hemisphere were found in the left eye.

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On systemic examination, erythema of the lower extremities (Fig. 1C) and right inguinal lymph node enlargement were discovered. With systemic doxycycline (100 mg) and gentamicin (90 mg) administration, fever subsided after three days. Bartonella infection was confirmed after 10 days with in-house indirect immunofluorescent assay (IFA) analysis (immunoglobulin G; cutoff points for seropositive titer at 1:64). Lymph node biopsy showed necrotizing granulomatous lymphadenitis (Fig. 1D). On the same day, the BCVA decreased to hand motion in the right eye. When asked, she could not specify when the vision loss began. The candle-wax-dripping sign in the left eye had progressed to vascular sheath with flame-shaped hemorrhages. Fluorescein angiography shows a rack of filling of the retinal arteries. Blocked fluorescence by retinal hemorrhage was found in the whole area of right eye and in the superotemporal quadrant of left eye. Inner-retinal hyper-reflectivity of the right eye and cystoid macular edema in the left eye were revealed (Fig. 2). The impression was central retinal artery and vein occlusion for the right eye and branch retinal artery and vein occlusion for the left eye, associated with severe vasculitis secondary to Bartonella infection. The patient was treated with a systemic methylprednisolone 500 mg, anticoagulant (Enoxaparin sodium 60 mg) and Rifampin (300 mg). Three month after disease onset, the BCVA in the right eye improved to 0.1. For photographs and medical records that consisted possible identification of the patient, a consent form was obtained from the patient for use of publication.

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The authors thank Professor Jin-Soo Lee, Department of Internal Medicine, Inha University School of Medicine, for his help with the in-house IFA analysis.


Funding: This research was supported by the Bio & Medical Technology Development Program of the National Research Foundation of Korea (NRF), funded by the Korean government, the Ministry of Science and ICT (MSIP) (NRF-2017M3A9E2056458).

Disclosure: The authors have no potential conflicts of interest to disclose.

Contributed by

Author Contributions: Conceptualization: Woo M, Kim SW. Investigation: Woo M, Ahn S. Writing – original draft: Woo M. Writing – review & editing: Ahn S, Song JY, Kim SW.


1. Kwon HY, Im JH, Lee SM, Baek JH, Durey A, Park SG, et al. The seroprevalence of Bartonella henselae in healthy adults in Korea. Korean J Intern Med. 2017;32(3):530–535. [PMC free article][PubMed] []