Lyme Disease?

To the Editor.  —Lightman and Brod¹ recently described a patient with a branch retinal artery occlusion, which they have attributed to Lyme disease, but they provide inadequate justification. As emphasized in my review of the neurologic and ophthalmic manifestations of Lyme disease,² which was cited by the authors in their report, many abnormalities attributed to Lyme disease have not had a causal relationship established, and this case seems to be another example of overdiagnosis of Lyme disease.The report describes a 37-year-old woman who developed a branch retinal artery occlusion following a systemic illness. An extensive workup revealed only an elevated Westergren erythrocyte sedimentation rate, a reactive fluorescent treponemal antibody absorbent test (FTA-ABS), and a Lyme enzyme-linked immunosorbent assay, the results of which were reported as positive. The patient apparently had syphilis and was treated with intravenous penicillin G, with resolution of her systemic symptoms. Positive FTA-ABS results