Salem Veterans Affairs Medical Center, Salem, Virginia.
Optom Vis Sci. 2022 Apr 1;99(4):394-399. doi: 10.1097/OPX.0000000000001861.
Lyme disease can have widespread and long-lasting systemic implications, and ocular manifestations of Lyme disease may be the only presenting symptoms of infection. As such, eye care providers can play a critical role in facilitating the diagnosis and treatment of this disease.
This case report describes an isolated sixth nerve palsy secondary to Lyme disease, which is a rare neuro-ophthalmic presentation. This report emphasizes the importance of considering Lyme disease in the setting of atypical nerve palsies to allow for appropriate treatment and prevent long-term complications of untreated disease.
A 63-year-old man presented with new-onset, painful diplopia for 1 day and was diagnosed with a right sixth nerve palsy. His medical history was significant for relapsing polychondritis with associated ocular complications, so his nerve palsy was presumed secondary to a flare of his systemic disease. However, secondary to complaints of new night sweats, infectious etiologies were also considered. The patient was initially treated with oral steroids with no improvement in his diplopia after being admitted to the hospital for further workup. Approximately 1 week after presentation, Lyme titers returned positive, and the diagnosis was revised to abducens palsy secondary to Lyme disease. The patient's nerve palsy rapidly resolved after oral therapy with doxycycline.
Lyme disease is a systemic illness that can have widely varying manifestations, including ocular findings. Eye involvement may be the only presenting symptom, allowing eye care providers to serve an important role in disease recognition and management.
莱姆病可引起广泛且持久的全身影响，莱姆病的眼部表现可能是感染的唯一首发症状。因此，眼科医生在促进这种疾病的诊断和治疗方面可以发挥关键作用。
本病例报告描述了一例由莱姆病引起的孤立性第六脑神经麻痹，这是一种罕见的神经眼科表现。本报告强调了在不典型神经麻痹的情况下考虑莱姆病的重要性，以进行适当的治疗并预防未经治疗的疾病的长期并发症。
一名 63 岁男性因新发、疼痛性复视 1 天就诊，被诊断为右侧第六脑神经麻痹。他的病史有复发性多软骨炎，伴有眼部并发症，因此他的神经麻痹被认为是继发于系统性疾病的发作。然而，由于新出现夜间盗汗的症状，也考虑了感染性病因。患者最初接受口服类固醇治疗，但在因进一步检查而住院后，复视无改善。在出现症状约 1 周后，莱姆病滴度呈阳性，诊断为莱姆病引起的展神经麻痹。患者口服多西环素治疗后，神经麻痹迅速缓解。
莱姆病是一种全身性疾病，其表现形式多种多样，包括眼部表现。眼部受累可能是唯一的首发症状，使眼科医生能够在疾病识别和管理方面发挥重要作用。
