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Dragana Skiljic, Martin Gustavsson, Leif Dotevall, Kerstin Norrsell, Marita Andersson Grönlund; Ophthalmological findings in neuroborreliosis verified by cerebrospinal fluid analysis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4171. doi: https://doi.org/.
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To evaluate and follow-up ophthalmological findings in individuals diagnosed with neuroborreliosis verified by cerebrospinal fluid (CSF) analysis.
During a 6-year period, 24 individuals (13 males and 11 females; mean age 43.5, range 8-69 years) with strong clinical suspicion of neuroborreliosis and regardless of ocular involvement, were referred to the Department of Ophthalmology from the Department of Infectious Diseases, both at Sahlgrenska University Hospital in Sweden. Before referral all subjects underwent serologic and CSF analyses of specific antibodies, immunoglobulin G (IgG) and immunoglobulin M (IgM). A structured history taking and detailed ophthalmological examination was performed prospectively.
Individuals with definite (n=16), possible (n=2), negative (n=4) and unknown (n=2) diagnosis of neuroborreliosis were confirmed. The majority (n=14) of those with definite and possible diagnoses had 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 diastase, strabismus and sixth nerve palsy. The number of symptoms and findings were correlated to levels of IgG (r=0.6, p<0.01) and IgM (r=0.6, p<0.02) in CSF. All subjects improved except for one patient who initially had fulminant papilledema and still suffered from optic disc atrophy and affected visual fields at last follow-up.
The majority of patients diagnosed with neuroborreliosis had ophthalmological symptoms and/or findings. Facial palsy was a common finding, however onset of diplopia and/or sixth nerve affection might be a first sign of neuroborreliosis. The number of ophthalmological symptoms and findings were correlated to the antibody levels in CSF. Ticks are becoming more widespread and abundant, resulting in a higher incidence of neuroborreliosis. Hence, this knowledge of ophthalmological symptoms and findings is of great importance.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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