OBJECTIVE: To describe a case of facial paralysis in Lyme disease who developed optic neuritis, discuss the importance of diagnosis and neurological complications of the disease. CASE REPORT: NSS, female, 29 years, referred for outpatients with peripheral facial paralysis (PFP) left three days ago and worsened progressively, associated with headache hemicranial left, dexamethasone and acyclovir. On examination, otoscopy, tympanic membrane integrates and shiny bilateral, rhinoscopy and oroscopy unchanged, left peripheral facial paralysis House-Brackmann V. Other cranial nerves unchanged. Audiometry: within normal limits. Three months after the beginning of the PFP patient returns complaining of "blurred vision" on the left for 10 days and improves the PFP. On examination, otoscopy, tympanic membrane and integrates brilliantly bilaterally, left peripheral facial paralysis House-Brackmann I, fundus left: papilledema, right unchanged, biomicroscopy: left eye, corneal thinning with normal right and center. Laboratory tests: serology in blood and cerebrospinal fluid (ELISA) for Lyme posivite. Brain MRI: thickening of the left optic nerve, hyperintense on T2 in their segments intraorbital, intra-canalicular and pre chiastic. Was treated with Ceftriaxone 2g day for 21 days, with improvement of the clinical picture. CONCLUSION: The facial paralysis is the most common manifestation of neurological complications of Lyme disease, however, associated with optic neuritis becomes rare and the prognosis is excellent, but if diagnosed and treated properly.