Ocular Manifestations of Systemic Disorders

This 59-year-old man had a 4-week history of malaise, myalgias, night sweats, weight loss, fatigue, and generalized headaches, and a few days before admission he developed a red eye OS secondary to exposure keratitis associated with a left-sided seventh nerve palsy. Subsequent evaluation disclosed a markedly elevated Lyme titer, and cerebrospinal fluid showing 138 white blood cells (76% lymphocytes, 9% polys, 5% monocytes), protein = 231, glucose = 77, CSF Lyme antibody index 2.8. Although he had no awareness of tick bites or erythema migraines, his occupation (filling liquid propane tanks in a rural, wooded, deer-infested community in central Wisconsin) placed him at risk for exposure to infected ticks.