On iritis and Lyme disease
Lyme disease is spreading
rapidly across the North American continent and with it, there is an increasing
danger of iritis.
What is iritis?
Iritis is an inflammation of
the iris. When the iris of the eye becomes inflamed, there may be pain, in or
around the eye. There may also be photophobia and pain experienced when light
is shone directly into the eyes. A person may have blurred or cloudy vision, as well as
redness of the eye, adjacent to the iris. There may be evidence of white blood
cells and pritin in the anterior chamber, synechia or adhesion of the iris to
the lens or cornea. Motion sickness, as well as other, more serious symptoms
may occur. (1)
What is Lyme disease?
Lyme disease is an infectious
disease carried by bacteria from the deer tick, known as the genus borrelia or
more specifically, borrelia burgdorferi sensu lato (bacteria). These ticks are
commonly spread by deer, but can be carried by mice, squirrels, birds or other small animals. They are found in woods, bushes, grasses and leaf litter.
After being bitten and infected
by a tick, a person may show evidence of an insect bite, with the stinger still embedded in the skin. Within several days, he or she may experience other
symptoms including a fever, headache, fatigue, depression or a skin rash, known
as erythema chronicum migrans. Later symptoms might include joint, heart and
nervous system involvement. (2)
Gerald W. Zaidman, M.D.,
Professor of Clinical Opthamology, in his work entitled, "Lyme Disease:
Treatment and Medication", suggests that the ocular manifestations of a
tick infection, may be depicted in three different stages. (3)
Stage one:
Mild conjunctivitis and
photophobia are experienced in stage one. Medical treatment does not require a
visit to the ophthalmologist. Treatment by a physician would include oral
antibiotics like tetracycline, doxycycline or amoxicillin for approximately 2-3
weeks. For those who are known to be allergic to penicillin, children or
pregnant women, erythromycin would be prescribed.
Stage two:
At stage two, the patient may
demonstrate neuro-opthalmological complications, like Bell's palsy. The
infection may manifest itself as a triad which consists of cranial nerve
palsy, meningitis and nerve root involvement. Blurred vision may occur in
conjunction with papilledema, optic atrophy and optic neuritis. This may be
treated with oral antibiotics for up to thirty days or with intravenous
antibiotic therapy. Bell's palsy may be treated with corticosteroids or
prednisone.
Stage three:
At this more advanced stage of
the disease process, keratitis, iritis and retinal detachment may be apparent.
There may be evidence of arterial occlusion and cranial nerve involvement, as well
as other, more serious or debilitating symptoms. Severe symptoms would require
potential treatment with medications, including beta-lactic antibiotics,
penicillin G, ceftriaxone or various combinations of intravenous medications
There is concern about the use
of multiple medications, as treating patients with a combination of intravenous
therapies can trigger a Jarisch-Herxheimer reaction, which is an allergic or
an inflammatory response of the skin, mucous membranes, viscera or nervous system.
Diagnosis of Lyme disease is
made by the evidence of a tick bite or a skin rash, but not always. The
organism can be detected in spinal fluid, urine and blood, in the early stages.
Immunofluorescent assay (IFA)
and enzyme linked immunosorbent assay (ELISA) may reveal both false positives
and false negatives, at different stages of the disease process, which makes an
accurate diagnosis difficult. The immunoblot (Western blot) test is considered
to be more reliable. Other tests, including a VDRL, may be done to rule out
other disease processes. An MRI or CT scan may be indicated.
To review this information
further or to obtain other pertinent information regarding iritis, as it
relates to Lyme disease, please see the following web sites.
http://emedicine.medscape.com/article/1202521-diagnosis
Anyone who has experienced what
appears to be a tick bite should remove the stinger carefully, wash the area
well with soap and water and contact his or he physician, should other symptoms
occur and persist for any length of time.
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