title: [Bilateral tonic pupil as the only remaining ophthalmic sign of Lyme disease: case report].
abstract: Lyme disease is a multisystemic disorder caused by Borrelia burgdorferi spirochete, transmitted by ticks. Mainly described in the northern hemisphere and rarely in Brazil. The purpose of this report is to describe a patient with Lyme disease who developed bilateral tonic pupil as the only remaining sign. A 13-year-old female with Lyme disease, presented with bilateral peripheral facial and oculomotor paralysis. After recovery from neurological abnormalities the patient sustained anisocoria, reduced fotomotor reflex, less than normal amplitude of accommodation, tonic pupil constriction for near objects and slow redialation in both eyes. Dilute 0.1% pilocarpine test was positive in both eyes, confirming the suspicion of bilateral tonic pupil. This is the first case report of bilateral tonic pupil caused by Lyme disease.
authors.affiliation: Clínica Oftalmológica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. ffugimoto@yahoo.com.br
authors.forename: Fernando
authors.initials: F
authors.lastname: Fugimoto
authors.forename: Ramon Coral
authors.initials: RC
authors.lastname: Ghanem
authors.forename: Mário Luiz Ribeiro
authors.initials: ML
authors.lastname: Monteiro
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000150:complications*; D008916:Miotics; D010862:Pilocarpine; D015845:Tonic Pupil / Q000175:diagnosis / Q000209:etiology*
chemical_list: D008916:Miotics; D010862:Pilocarpine