Patient: 61 years of age, female, BCVA 0.2 at OD, 1.0 at OS, IOP 16/17mmHg. Ocular Medical History: two months after erythema migrans blurred vision in left eye. General Medical Information: in 2012 characteristic erythema migrans with positive Lyme antibody test, treatment with doxycycline, months later development of optic nerve atrophy and prolonged central motor conduction time. Purpose: to present unilateral optic nerve atrophy in suspected Lyme disease. Methods: Colour Photography Posterior Pole, Spectral Domain Optical Coherence Tomography (SD-OCT), Visual Field, Visual Evoked Potential (VEP). Findings: Colour Photography Posterior Pole: pale optic nerve head, small retinal vessel diameter. SD-OCT: thinned retinal nerve fiber layer thickness. Visual Field: concentric visual field loss. VEP: decreased amplitude of evoked potential. Discussion: Involvement of the optic nerve, either because of inflammation or increased intracranial pressure, is a rare manifestation of Lyme disease. Lesser reported (1) that the spirochete in Lyme disease invades the eye early and remains dormant. Neuro-ophthalmic manifestations include neuroretinitis, optic atrophy, disc edema, and involvement of multiple cranial nerves (seventh nerve paresis, Bell's palsy). Criteria for Lyme disease include the lack of evidence of other disease, other clinical findings consistent with Lyme disease, occurrence in patients living in an endemic area, positive serology, and, in most cases, response to treatment. Literature: (1) Lesser RL. Ocular manifestations of Lyme disease. Am J Med. 1995 Apr 24;98(4A):60S-62S.