Tick infestation on the lower eyelid in an elderly female: a case report

Abstract

This article presents a case of tick infestation of the lower eyelid. A 58-year-old female presented to Ophthalmology OPD at Nepalgunj medical college with a small whitish lesion on medial aspect of the left lower eyelid since 7 days. On a detailed ocular examination, a tick was found to be masquerading as a pustule. This case report emphasizes the relation of tropical diseases in ophthalmology and the subsequent need of understanding the pathophysiological aspect of tropical diseases to avoid further systemic complications.

Introduction

Ticks, the acarine ectoparasites of the family (Ixodidae), are among the most important vectors of human and animal diseases (Liolios and Goldsmith 2009). They live by hematophagy and are responsible for a number of potentially fatal diseases including Crimean-Congo hemorrhagic fever, Lyme disease and rickettsiosis (Ergönül 2006; Güner et al. 2003; Orkun et al. 2014). Ticks have been associated with localized lesions resembling erythema chronicum migrans, foreign body granuloma, lymphoid hyperplasia and tick-related alopecia (Castelli et al. 2008). In recent years vector borne disease has gained attention in Nepal due to newly reported cases of Lyme disease and scrub typhus. However, the very first reported case of Lyme disease was not that long ago (Pun et al. 2018). Despite tick borne disease being a common topic, tick infestation of ocular tissues is a rare occurrence and probably this is the first reported case of tick infestation in ocular adnexae from Nepal.

Case report

58-year-old female presented with a small white lesion on the medial aspect of the left lower eyelid since 7 days to Ophthalmology OPD at Nepalgunj medical college. There was tenderness and a constant discomfort around the lesion. She believed it to be a collection of pus. Ophthalmologic examination showed a whitish lesion of 3 mm × 3 mm overlying the skin (Fig. 1). On slit lamp examination, the lesion was found to be a tick instead of a pustule (Fig. 2). The head of the tick was found to be embedded in the skin of the eyelid. Its body moved during manipulation with fine forceps. Also, we came to know that the patient had a close contact with farm animals. The remainder of the eye examination, including visual acuity and anterior segment examination, was normal. The patient did not have any systemic symptoms at presentation. The tick was successfully removed using forceps. The patient’s blood was drawn to screen for thrombocytopenia; the platelet count was normal at presentation and after a month. During follow-up, 1 week post presentation, the patient was comfortable with no residual lesions at the site of inoculation.

Fig. 1.

Tick infestation of left lower eyelid

Fig. 2.

Eggs visible in 16 × magnification around the tick

Discussion

Ocular infestation of ticks especially on the eyelid or conjunctiva has been reported (Aydin and Bakirci 2007; Celik et al. 2013). Conjunctivitis, uveitis, keratitis, and vasculitis are the most frequent symptomatic eye manifestations (Santos-Bueso et al. 2006). Removing ticks and its embedded body parts from the affected tissue is of prime importance not only to prevent tick-borne diseases but also to prevent possible abscess/granuloma formation. Ticks should be removed at the earliest with careful manipulation from the affected tissue. Complete blood count should be sent after removal of the tick and at 1 month follow-up to rule out different tick borne diseases and be monitored closely for local and systemic complications. The administration of systemic antibiotic prophylaxis administration after tick bites remains controversial. The Infectious Diseases Society of America does not recommend systemic antibiotic prophylaxis following a tick bite (Uzun et al. 2016). Since our patient did not have any systemic features we did not administer systemic antibiotics.

Conclusion

Tick infestation of the human eyelid is rare. In cases with ticks in ocular adnexae, timely mechanical removal of ticks is an easy, safe, and effective method of preventing tick-associated systematic and local ocular complications. This study highlights the need of knowledge of tropical medicine for ophthalmologists without which prevention of systemic complications resulting from vector borne diseases is clearly impossible.

Authors’ contributions

SP drafted the manuscript, PS and SY helped in managing the patients and making sure the patient.

Funding

No funding was received.

Data availability

Data available within the article or its supplementary materials.

Compliance with ethical standards

Conflict of interest

None.

Informed consent

Informed written consent.

Consent for publication

Provided to the journal.