November 2019


Research Highlights
Should you be screening for Lyme in uveitis patients?

by Liz Hillman EyeWorld Editorial Co-Director

As the weather cools, concern over tick season and the possibility of tick-borne disease transmission, such as Lyme disease, drops.
It’s rare for Lyme disease to affect the eye, but despite this rarity, Hatice Nida Sen, MD, said screening for Lyme disease is routinely done for patients with ocular inflammatory disease who are in Lyme endemic areas.
Dr. Sen and her colleagues wanted to find out if such screening was gratuitous. They conducted a review of 648 patients who were seen at the uveitis clinic at the National Eye Institute, 572 of whom lived in areas where Lyme was endemic. An eye exam was performed as well as a panel of laboratory testing for various conditions, including Lyme, regardless of other signs that could suggest these conditions.
According to the paper, 27 patients from the group of 572 tested positive in a first-tier test for Lyme.1 Two patients were positive on immunoblot analysis and diagnosed with Lyme-associated uveitis. This represented 0.31% of the study group. False positives were registered on the immunoblot tests for the remaining 25 individuals.
Serological evidence of Borrelia burgdorferi (the bacteria that causes Lyme) was positive in 7.4% of patients (two out of 27). This, according to the researchers, means 323 people would need to be screened to detect a true case of Lyme-associated uveitis.
Given the low prevalence of Lyme in the study cohort, as well as a lack of history that would suggest Lyme and the cost of screening (screening in this study ranged from $30,000–$65,000), the study authors do not suggest such routine screening for B. burgdorferi infection that could be causing the uveitis.
According to the University of Illinois College of Medicine, conjunctivitis, uveitis, inflammation of the optic nerve, and sensitivity to light and floaters are ocular symptoms that can be associated with Lyme disease.2 This association, however, is rare and often occurs at later-stage disease.
The two cases in the Caplash et al. study that had Lyme presented with intermediate uveitis and improved on antibiotics followed by immunomodulatory treatment.

About the doctor

Hatice Nida Sen, MD
Director, Uveitis and Ocular
Immunology Fellowship Program
National Eye Institute
Bethesda, Maryland

Relevant financial interests

Sen: None


1. Caplash S, et al. Usefulness of routine Lyme screening in patients with uveitis. Ophthalmology. 2019. Epub ahead of print.
2. Lyme disease and the eye. University of Illinois College of Medicine. Accessed July 9, 2019.

Should you be screening for Lyme in uveitis patients? Should you be screening for Lyme in uveitis patients?
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