Tick infestation on the lower eyelid in an elderly female: a case report
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ORIGINAL ARTICLE
Tick infestation on the lower eyelid in an elderly female: a case report Sanket Parajuli1
•
Pooja Sunar2 • Sanjeev Yadav2
Received: 20 July 2020 / Accepted: 29 September 2020 Ó Indian Society for Parasitology 2020
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.
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.
Keywords Tropical eye disease Parasitic infestation Ophthalmolgy Ocular disease Parasitic infestation of eye Parasite and eye
Case report
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 (Ergo¨nu¨l 2006; Gu¨ner et al. 2003; Orkun et al. 2014). Ticks have been associated with & Sanket Parajuli [email protected] Pooja Sunar [email protected] Sanjeev Yadav [email protected] 1
Reiyukai Eiko Masunaga Eye Hospital, Banepa, Nepal
2
Nepalgunj Medical College, Kohalpur, Nepal
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 9 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 fo
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