DIAGNOSIS AND CLINICAL CHARACTERISTICS OF OCULAR LYME BORRELIOSIS

PURPOSE: To establish a diagnosis, in a group of patients we studied t he characteristics of ocular Lyme borreliosis. METHODS: During a two y ear period, 236 patients with prolonged external ocular inflammation, uveitis, retinitis, optic neuritis, or unexplained neuro-ophthalmic sy mptoms were examined for Lyme borreliosis. Antibodies to Borrelia burg dorferi were measured by indirect ELISA and western blot. Cerebrospina l fluid was also analyzed by polymerase chain reaction. RESULTS: Ocula r Lyme borreliosis was diagnosed in ten patients-on the basis of medic al history, clinical findings, and serologic test results. Results of ELISA disclosed that five patients were seropositive, two patients sho wed borderline reactivity, and three patients were seronegative. Four of the five patients with borderline or negative results by ELISA had a positive result by western blot analysis. In one seropositive patien t, polymerase chain reaction verified a gene of B. burgdorferi endofla gellin from the vitreous and cerebrospinal fluid specimen. In five of the six patients with known onset of the Borrelia infection, the ocula r disorder appeared as a late manifestation. Abnormalities of the post erior segment of the eye, such as vitreitis, retinal vasculitis, neuro retinitis, choroiditis, and optic neuropathy were seen in six patients . Bilateral paralytic mydriasis, interstitial keratitis, episcleritis; and anterior uveitis were seen in one patient each. CONCLUSIONS: Late phase ocular Lyme borreliosis is probably underdiagnosed because of w eak seropositivity or seronegativity in ELISA assays. Ocular borrelial manifestations show characteristics resembling those seen in syphilis .