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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 341-342

No-touch management in tick infestation of periocular skin


Department of Ophthalmology, Amala Institute of Medical Sciences, Thrissur, Kerala, India

Date of Submission11-Jun-2021
Date of Acceptance23-Sep-2021
Date of Web Publication13-Apr-2022

Correspondence Address:
Vaisna Gopi
Department of Ophthalmology, Amala Institute of Medical Science, Thrissur - 680 555, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1620_21

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  Abstract 


Ixodidae ticks are vectors of Lyme borreliosis, Rocky Mountain spotted fever, tick-borne encephalitis, and relapsing fever. We present a case of eyelid tick infestation in a 49-year-old patient for 1 week. A slit-lamp examination suggested it to be a tick tethered on the patient's skin. Complete removal of the tick was done with 2% lignocaine infiltration locally around the swelling. The tick fell off from the periocular skin without any further manipulation. On entomology evaluation, it was categorized to be a hard tick Rhipicephalus sanguineus belonging to the Ixodes family. The patient was put on topical moxifloxacin and chloramphenicol eye ointment. The patient was followed up after 5 days and after 2 weeks and was found to be normal.

Keywords: Eyelid, lignocaine, tick


How to cite this article:
Gopi V, Kamaladevi LV, Skariah CK. No-touch management in tick infestation of periocular skin. Indian J Ophthalmol Case Rep 2022;2:341-2

How to cite this URL:
Gopi V, Kamaladevi LV, Skariah CK. No-touch management in tick infestation of periocular skin. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 May 26];2:341-2. Available from: https://www.ijoreports.in/text.asp?2022/2/2/341/342894



The Ixodes genus refers to hard-bodied ticks of the family Ixodidae that are vectors of Lyme borreliosis, Rocky Mountain spotted fever, tick-borne encephalitis, and relapsing fever.[1] Ixodes ticks secrete anticoagulant, immunosuppressive, and anti-inflammatory substances into the area of the tick bite. There were similar cases reported but the removal was using forceps.[2],[3] There are various methods described for the removal of eyelid tick infestation. But the removal of eyelid tick with 2% plain lignocaine infiltration has not been well-documented. From our experience, it is the least invasive, quick, patient-friendly method which also ensures the removal of the tick.


  Case Report Top


A 49-year-old female patient presented with progressively increasing swelling below the right lower eyelid of 1-week duration. It was associated with severe pain for which the patient presented to the Ophthalmology outpatient department. History revealed that the patient was residing in a hilly area and had contact with cattle prior to the onset of complaints. The torchlight examination showed a single swelling below the lower lid of size 5 mm, globular, mustard yellow, tethered onto skin in the superior part with surrounding mild edema, erythema, and local tenderness [Figure 1]. A slit-lamp examination suggested it to be a tick tethered on the patient's skin. The Best corrected visual acuity in the eye was 6/9. The rest of the anterior segment and posterior segment were within normal limits.
Figure 1: (a) Shows torchlight examination of the swelling below the lower eyelid. (b) Shows a slit-lamp photograph of the tick

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1 cc of 2% lignocaine was infiltrated locally around the swelling [Figure 2]. In a few seconds, the tick fell off from the periocular skin without any further manipulation [Video 1][Additional file 1]. The slit-lamp examination of the site revealed no residual parts of the tick. The specimen was put in a glass bottle and sent for entomology evaluation. It was categorized to be a hard tick Rhipicephalus sanguineus belonging to the Ixodes family. The patient was put on topical moxifloxacin and chloramphenicol eye ointment. She was evaluated for systemic manifestations of zoonoses including complete blood profile and was negative. She was followed up after 5 days and after 2 weeks and was found to be normal.
Figure 2: Shows tick (red arrow) and the surrounding area being infiltrated with 2% lignocaine

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  Discussion Top


The Ixodes genus refers to hard-bodied ticks of the family Ixodidae that are vectors of Lyme borreliosis, Rocky Mountain spotted fever, tick-borne encephalitis, and relapsing fever.[1] Ixodes ticks secrete anticoagulant, immunosuppressive, and anti-inflammatory substances into the area of the tick bite. These substances help the tick to adhere tightly to the skin and obtain a blood meal without the host noticing it.[4] Removing ticks completely from the affected tissues is challenging but vital in the prevention of possible abscess, granuloma, or other local lesions as well as tick-borne systemic diseases.[5]

Monopolar cautery is a novel technique. It is simple to perform, requiring only a few sequential thermal burns to the tick body to induce its detachment. However, this technique might be more suitable for ticks with shallow bites because of trauma to the surrounding ocular tissues.[6]

The use of sharp forceps is best avoided because twisting off the head might cause leakage of the ticks' potentially infectious body fluids and increase the risk for transmission of certain zoonoses, particularly Lyme disease. Possible retained mouthparts in ocular tissues, as well as fragmentation of its body, can complicate the removal further.[5]

Wait and watch is not a safe option. Evidence shows that the risk of disease transmission and infection increases after the first 24 h of tick infestation and is especially high after 48 h. Therefore, ticks should be removed immediately, carefully, and least invasively from the affected tissue.[5],[7]

From our experience, it is possible to dislodge and remove the tick by injection of the local site with a local anesthetic without any further manipulation. This is possibly due to lignocaine causing paralysis of the tick, though there is no definite literature evidence for the same. This least invasive, quick, and most patient-friendly method also ensures the removal of the tick in toto. Using lignocaine with epinephrine can cause blanching of the area, and thereby, removing the blood; the tick may be induced to release on its own accord.[4] Topical lidocaine (xylocaine) on the tick is not recommended as it may induce the tick to salivate and regurgitate into the attachment site, theoretically increasing the risk of infection.[8]


  Conclusion Top


Infiltration of local site with local anesthetic is one of the safest, least invasive, and fastest methods for the removal of ticks.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jaroudi MO, Mansour AM, Ma'luf R, Meduri A, Tawil A, Younis MH. Large tick (ixodes) infestation of the upper eyelid presenting as eyelid mass and preseptal cellulitis. Case Rep Ophthalmol 2019;10:403-7.  Back to cited text no. 1
    
2.
Varma RR, Varma P, Kumar A. Tick infestation of the eyelid. Rev Soc Bras Med Trop 2020;53:e20190599. doi: 10.1590/0037-8682-0599-2019.  Back to cited text no. 2
    
3.
Lee YJ, Han ET, Han SB. Tick infestation of the upper eyelid. Korean J Ophthalmol 2020;34:491-2.  Back to cited text no. 3
    
4.
John M, Raman M, Ryan K. A tiny tick can cause a big health problem. Indian J Ophthalmol 2017;65:1228-32.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Tomar M, Gautam N, Chauhan A, Gupta L, Singh S. Eyelid tick manifestation in subhimalayan region – a case series of 3 cases. Delhi J Ophthalmol 2019;30:51-4.  Back to cited text no. 5
    
6.
Foo LL, Ting DS, Ng WY, Quah BL. Novel technique of dog tick removal from the eyelid. Acta Ophthalmol 2016;94:e819-20.  Back to cited text no. 6
    
7.
Uzair M, Varma D. Tick infestation of upper eyelid. Indian J Ophthalmol 2020;68:2269.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Gammons M, Salam G. Tick removal. Am Fam Physician 2002;66:643-5.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

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