Ocular findings in patients with lyme disease: a systematic review and meta-analysis.

BACKGROUND

Lyme disease ophthalmic manifestations are underestimated due to a wide variety of clinical presentations and a lack of robust evidence. We performed a systematic review and meta-analysis to analyze the prevalence of ocular findings in patients diagnosed with Lyme Disease.

METHODS

This systematic review and meta-analysis was conducted following PRISMA guidelines. We systematically searched PubMed, Embase, Lilacs, and the Cochrane Central Register of Controlled Trials databases for studies enrolling patients diagnosed with Lyme disease who exhibited ocular manifestations until April 2024. The latest version of the Newcastle-Ottawa Scale (NOS) was utilized to evaluate the risk of bias. All statistical analyses were performed using RStudio statistical software version 4.3.2. Heterogeneity was assessed using I² statistics.

RESULTS

A total of 21 studies were included, comprising 859 patients. The population was mostly male (52%), with a mean follow-up of 4.6 ± 3.14 years. Diplopia and strabismus were assessed in only five studies, yet they were the most reported ocular manifestations, with a prevalence of 50.74% (CI: 36.73-65.61; I² = 10%). Anterior segment findings, including conjunctivitis, keratitis, and cataracts, had a pooled incidence of 23.76% (CI: 13.83-37.71; I² = 76%). Ten studies analyzed posterior segment findings, which included retinitis, chorioretinitis, neuroretinitis, posterior uveitis, intermediate uveitis, and retinal vasculitis, resulting in an overall prevalence of 19.66% (CI: 7.87-41.23; I² = 74%). Third cranial nerve palsy was found in 18.65% of the cases (CI: 8.91-34.95; I² = 62%), while optic nerve findings were present in 10.76% of the cases (CI: 5.43-20.22; I² = 24%).

CONCLUSION

The results of this systematic review and meta-analysis including over 859 patients suggest that ocular findings in Lyme disease such as conjunctivitis, anterior uveitis, strabismus and diplopia) are common and should raise the suspicion of infection even before serological diagnosis.