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| CLINICAL IMAGE |
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| Year : 2023 | Volume
: 16
| Issue : 1 | Page : 175-176 |
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Hiding in plain sight – Tick infestation of the eyelid
Sonali Rao, Rachana Shivaram
Department of Ophthalmology, B. W. Lions Super Speciality Eye Hospital, Bengaluru, Karnataka, India
| Date of Submission | 20-Apr-2021 |
| Date of Decision | 31-May-2021 |
| Date of Acceptance | 11-Oct-2021 |
| Date of Web Publication | 12-Dec-2022 |
Correspondence Address:
Rachana Shivaram
988, 1st Cross, 2nd Main, KN Extension, Yeshwanthpur, Bengaluru - 560 022, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ojo.ojo_126_21
 Abstract | | |
Keywords: Eyelid, infestation, Lyme disease, tick
How to cite this article:
Rao S, Shivaram R. Hiding in plain sight – Tick infestation of the eyelid. Oman J Ophthalmol 2023;16:175-6 |
| Presentation | |  |
A 32-year-old male, reported with complaints of pain, itching, and swelling in the right lower eyelid for 3 days.
There was lid edema with a localized brownish mass near the medial canthus, which on slit-lamp examination was revealed to be a live tick, adherent to the skin of the lower eyelid [Figure 1] and [Figure 2]. | Figure 1: Slit-lamp image showing a tick adherent to the medial canthus of the right eye
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 | Figure 2: Magnified slit-lamp image showing: A – markings on the body of the tick. B – the legs of the tick underneath its body
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The tick was removed in toto using blunt forceps, revealing an area of excoriation and active bleeding [Figure 3] and [Figure 4]. Local application of gatifloxacin 0.3% eye ointment was advised for 1 week. The patient was counseled about the symptoms of Lyme disease such as rashes, fever, and joint pains and asked to report back if he noticed any of the same. | Figure 3: Slit-lamp image showing an area of excoriation in the eyelid, after removal of the adherent tick
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 | Figure 4: Slit-lamp image showing an area of excoriation and bleeding in the eyelid, after removal of the adherent tick
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| Discussion | | |
Ectoparasitic arachnids of the suborder Ixodida, ticks are vectors of diseases such as Crimean-Congo Hemorrhagic Fever, Lyme disease, tularemia, and Q fever.[1]
Ocular manifestations include conjunctivitis, uveitis, keratitis, and vasculitis. Bites confined to the eyelids have manifestations ranging from pruritis to severe blepharitis.[2]
Ticks at the lid margin can mimic the appearance of a hemangioma, nevus, or epidermal cyst.[3] Localization to the eyelid margin may be due to the ticks' preference for warm, moist environments, and easy access to a pore without the skin as a barrier.[4]
Ticks secrete anticoagulant and anti-inflammatory substances into the area of the bite, obtaining a blood meal without the host noticing and allowing pathogens to establish a foothold in the host.
It is imperative to remove the tick at the earliest to prevent tick-borne diseases and the formation of abscess or granuloma. The risk of disease transmission increases after the first 24 h of tick infestation.[5]
The safest option for removal is with blunt forceps. Sharp forceps should be avoided, as it might cause leakage of the ticks' body fluids and increase the risk for transmission of Lyme disease.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Uzun A, Gök M, İşcanlı MD. Tick infestation of eyelid: Two case reports. Turk J Ophthalmol 2016;46:248-50.  |
| 2. | Dağdelen S, Aykan U, Cetinkaya K. Phthriasis palpebrarum can resemble tick larva infestation in an eyelid. J AAPOS 2013;17:440-2. |
| 3. | Price KM, Woodward JA. Management of tick infestation of the eyelid. Ophthalmic Plast Reconstr Surg 2009;25:328-30. |
| 4. | Bolgiano EB, Sexton J. Tick-borne illnesses. In: Marx JA, Hockberger RS, Walls RM, editors. Rosen's Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby Elsevier; 2009. |
| 5. | Keklikçi U, Unlü K, Cakmak A, Akdeniz S, Akpolat N. Tick infestation of the eyelid: A case report in a child. Turk J Pediatr 2009;51:172-3. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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