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A. Sauer, L. Ballonzoli, M. Saleh, T. Bourcier, C. Speeg-Schatz; Paralytic Strabismus as a Rare Feature of Lyme Disease. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2567. doi: https://doi.org/.
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Lyme disease is a multi-system organ disorder caused by Borrelia sensu lato bacterias. Although ocular manifestations have been already reported, they remain rare features of the disease (< 5%). The aim of the present study is to focus on well known manifestations of ocular Lyme disease and also, on paralytic strabismus that is a rare clinical finding.
Observational case series. Inclusion of five patients with Lyme borreliosis-related paralytic strabismus treated in the Department of Ophthalmology of Strasbourg University Hospital (Strasbourg, France) between 2000 and 2007. All patients underwent medical and ophthalmological evaluations. The diagnosis of Lyme borreliosis was based on medical record (tick bite in an endemic area), ocular (visual loss, diplopia, pain) and systemic findings (erythema migrans, neurological manifestations, arthritis). Diagnosis criterias encompassed the presence of antibodies related to Borrelia species and/or detection of bacterial DNA by polymerase chain reaction while excluding other infectious and inflammatory conditions. In addition of paralytic strabismus, ocular surface inflammation, intraocular inflammation, and neuro-ophthalmological manifestations compatible with the diagnosis of Lyme borreliosis were recorded.
Paralytic strabismus was diagnosed in five patients. All complained of acute diplopia. Abducens palsy associated with the second phase of Lyme borreliosis was diagnosed in all cases. Determination of antibodies related to Borrelia was positive in all patients. One patient had concomittant anterior uveitis with positive Borrelia DNA detection in aqueous humor. All patients were treated with antibiotics (doxycycline or ceftriaxone) and resolution of ocular symptoms was obtained within 2 to 12 weeks, except in one patient who requested muscle surgery. No recurrence of Lyme disease was observed.
Ocular manifestations occur in all stages of Lyme disease. Paralytic strabismus is rarely reported in the literature. Even if the involvement of Lyme Borreliosis in the pathophysiology of strabismus is difficult to prove, diagnosis of Lyme Borreliosis should always be considered in presence of ocular symptoms in an endemic area, especially in presence of paralytic strabismus.
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