Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden.
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Acta Ophthalmol. 2019 Feb;97(1):44-52. doi: 10.1111/aos.13884. Epub 2018 Aug 26.
To evaluate and follow-up ophthalmological findings in individuals diagnosed with neuroborreliosis, confirmed by cerebrospinal fluid (CSF) analysis.
Twenty-four individuals (13 males), mean age 43.5 ± 18.2 years, with strong clinical suspicion of neuroborreliosis, were referred to the Department of Ophthalmology by the Department of Infectious Diseases at Sahlgrenska University Hospital, Gothenburg, Sweden. All subjects underwent serological and CSF analysis. A structured history taking and a detailed ophthalmological examination were performed prospectively.
Diagnosis for neuroborreliosis was confirmed as definite in 16, possible in two and negative in four individuals, while two had unknown diagnosis. The majority (n = 14/18) with definite and possible diagnoses had ophthalmological symptoms and/or findings either in history or at examination. The most common findings were visual disturbance, diplopia, red eyes, photophobia, facial palsy with palpebral diastasis, strabismus and sixth nerve palsy. The number of symptoms and findings was correlated with immunoglobulin G (IgG)/IgM in CSF (r = 0.6, p = 0.009/0.016; Spearman's correlation). All subjects improved, except one with initially fulminant papilloedema, who still suffered from optic disc atrophy and affected visual fields at the last follow-up.
The majority of patients diagnosed with neuroborreliosis had ophthalmological symptoms and/or findings. Facial palsy with palpebral diastasis was a common finding. Onset of diplopia and/or sixth nerve affection may be a first sign of neuroborreliosis. Number of ophthalmological findings was correlated with the CSF antibody titre. Ticks are becoming more widespread and abundant, resulting in a higher incidence of neuroborreliosis. Hence, the knowledge of ophthalmological symptoms and findings is of great importance.
评估和随访经脑脊液（CSF）分析确诊的神经莱姆病患者的眼科发现。
24 名（13 名男性）个体被传染病科转介到瑞典哥德堡萨尔格伦斯卡大学医院的眼科，这些个体强烈怀疑患有神经莱姆病。所有患者均接受血清学和 CSF 分析。前瞻性地进行了详细的病史采集和眼科检查。
16 例诊断为明确的神经莱姆病，2 例为可能的神经莱姆病，4 例为阴性，2 例诊断不明。大多数（n=14/18）有明确和可能诊断的患者在病史或检查中均有眼部症状和/或发现。最常见的发现是视力障碍、复视、眼红、畏光、面瘫伴睑裂增大、斜视和第六脑神经麻痹。症状和发现的数量与 CSF 中的免疫球蛋白 G（IgG）/IgM 呈正相关（r=0.6，p=0.009/0.016；Spearman 相关）。除了一名最初患有暴发性视乳头水肿的患者外，所有患者均有所改善，该患者仍患有视乳头萎缩和受影响的视野。
大多数诊断为神经莱姆病的患者有眼部症状和/或发现。面瘫伴睑裂增大是常见的发现。复视和/或第六脑神经受累的出现可能是神经莱姆病的首发症状。眼科发现的数量与 CSF 抗体滴度呈正相关。蜱虫越来越广泛和丰富，导致神经莱姆病的发病率更高。因此，了解眼科症状和发现非常重要。
