Lyme disease from an ophthalmological point of view

The first case of Lyme disease was described more than 25 years ago in the city of Lyme, Connecticut (USA) and although the responsible pathogenic organism is known (Borrelia Burgclorferi) as well as its vector (a tick from the lxode genus), it is still underdiagnosed and often poorly known by practitioners. The symptomatology is classically divided into three phases depending on the time between the tick bite and the first symptoms. (1) The early localized stage (7-10 days following the bite, with erythema extending centrifugally from the bite site); (2) the disseminated stage (a few days to several months after the bite, inducing cutaneous, articular, nervous, cardiac and ocular manifestations); (3) the chronic infectious stage, which begins months or years after the onset of the disease and involves the skin, joints, nervous system, heart and eyes. However, in a number of cases this clinical division of the disease is not easily applied. We describe three cases of atypical ocular manifestations to illustrate this problem. Recently developed laboratory tests help confirm the diagnosis but should not be used without a good knowledge of the disease. This study aims to emphasize the difficulty of diagnosis and the importance of appropriate treatment and to avoid potentially permanent complications.