Premium
Ophthalmological findings in neuroborreliosis – a prospective study performed in western Sweden
Author(s) -
Škiljić Dragana,
Gustavsson Martin,
Dotevall Leif,
Norrsell Kerstin,
Grönlund Marita Andersson
Publication year - 2019
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.13884
Subject(s) - medicine , neuroborreliosis , diplopia , photophobia , lyme neuroborreliosis , pediatrics , palsy , surgery , borrelia burgdorferi , pathology , alternative medicine , antibody , immunology
Purpose To evaluate and follow‐up ophthalmological findings in individuals diagnosed with neuroborreliosis, confirmed by cerebrospinal fluid ( CSF ) analysis. Methods 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. Results 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. Conclusion 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.