It’s safe to say that one of the most well-known signs of Lyme disease is the bull’s-eye rash — a red, circular, expanding rash that may develop following a bite from a tick infected with Borrelia burgdorferi bacterium (or, more rarely, Borrelia mayonii).

This rash, however, doesn’t show up on everyone infected with Lyme disease. The Centers for Disease Control and Prevention (CDC) estimates that 70% to 80% of patients experience this symptom. But watching for other symptoms — fever, headache, fatigue — is important, because Lyme disease can spread throughout your body to other organs, including the heart and nervous system.

You’ll also want to keep an eye on your eyes. “The eyes can be affected at any stage of Lyme disease,” says Griffin Durias, O.D., an optometrist whose practice is located inside the America’s Best Contacts & Eyeglasses in Machesney Park, Illinois.

Though it’s rare, Lyme can cause conjunctivitis (often referred to as pink eye). You might notice a pink-eye-like appearance, where the eyes appear red, watery, itchy, and irritated, Dr. Durias says. That’s caused by inflammation outside of the eye from the Lyme infection, he explains.

In fact, research indicates that eye problems from tick-borne diseases send people to the eye doctor far more often than you might think — and when patients and providers aren’t aware of the link, it can affect eye treatment.

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Why Treating Lyme Disease Quickly Is Crucial

When not addressed swiftly, Lyme disease can trigger inflammation in the inside structures of the eye, Dr. Durias says. These conditions are known as uveitis (which affects the colored portion of the eye), vitritis (targeting the jelly-like part of the eye), and optic neuritis (an inflammation of the optic nerve).

If those conditions occur, your eyes may hurt, you’ll experience a decrease in vision quality, and your eyes will be red.

“Retinal detachments have also been reported, which could lead to severe vision loss,” adds Dr. Durias. (The retina is a thin layer of tissue at the back of the eye; retinal detachment is a medical emergency, according to the National Eye Institute.)

While experts know that Lyme disease can show up in the eyes, the exact reason isn’t fully understood. “We don’t know why some Lyme disease shows up in the beginning as a pink eye and sometimes shows up in later stages with more severe swelling,” Dr. Durias says.

Other symptoms of an advanced infection, according to the CDC, include: 

• Severe headaches
• Neck stiffness
• Facial palsy (a condition that causes sudden, temporary weakness of the muscles on one side of the face)
• Arthritis
• Muscle and joint pain
• Nerve pain

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How to Protect Yourself from Ticks This Season

Although anyone can be bitten by a tick, you’re obviously more at risk if you spend a lot of time outdoors, especially in wooded areas of the Northeast, Mid-Atlantic, Upper Midwest, and Pacific Coast regions of the United States, notes the National Library of Medicine.

Keep in mind that although ticks are out and about more in the summer, you can still get bitten in the fall or spring.

To keep ticks at bay, keep these tips in mind:

• Use insect repellent containing 20% or more DEET, picaridin, or IR3535, advises the U.S. Department of Agriculture.
• Consider clothing treated with permethrin, which kills ticks on contact. This may be especially smart to wear while camping.
• Use tick-prevention medication on dogs to prevent the insects from hitching a ride into your home on your four-legged pals.
• Always shower when you come inside after a hike or a session in the garden, and while you do so, check yourself all over for ticks. Use a mirror to look at all parts of your body — and be sure to search well, as ticks like to hide in hard-to-see spots, such as your hairline, armpits, and groin.

What to Do if You Find a Tick

If you’ve been bitten by a tick, take these steps:

• Use fine-tipped tweezers to grasp the tick close to your skin and pull to remove it, advises the CDC. Dispose of the tick (flushing it down the toilet works) and wash the area where it was with soap and water.
• Call your primary care physician. They may suggest watching for common Lyme symptoms, such as fever, fatigue, and the classic bull’s-eye rash. And if Lyme disease-causing ticks are common in your area, they may order lab tests.
• If symptoms develop and/or lab tests detect Lyme disease, the disease is treated with oral antibiotics, according to the Mayo Clinic.

In some people, the symptoms stick around long term, a condition called post-treatment Lyme disease, which studies show may also affect eye health.

What to Do if Eye Symptoms Develop After a Tick Bite

Keep in mind that pink eye, which may be an early warning sign of Lyme, has many different causes, including bacteria, viruses, and allergies. It’s tough to narrow down the cause on your own. For more information on the lesser-known causes, read “What Causes Pink Eye and How to Treat it Fast” here.

“Whether you suspect Lyme or not, any time your eye is pink and irritated, see your optometrist,” says Dr. Durias.

The treatment you get will depend on why your eye is red and irritated, but this is definitely a good time to mention to your optometrist if you were recently camping or spending time outdoors in areas with ticks.

If you have been diagnosed with Lyme disease, that’s another bit of info your optometrist should have. “Knowing this information, we would be more vigilant about looking for changes inside the eye related to Lyme disease,” says Dr. Durias.

For any serious eye symptoms, such as pain or a sudden decrease in vision, see your eye doctor right away.

“Many people see the optometrist as someone who gives them new contact lenses or glasses, but they don’t realize that there’s a whole other aspect to our care,” Dr. Durias says. “We’re checking for eye health as well. We want to make sure you’re seeing your best — and that your eyes are healthy and there isn’t anything going on behind the scenes.”