(CR43) Tick Infestation of Eyelid, a Thoughtful Management

Introduction:

Tick infestation of the eyelid is under-reported in Malaysia. Presentation is delayed due to mild presenting symptoms that is disproportionate to the deep tissue invasion. Ticks are known vectors of certain infectious diseases; hence complete removal is vital to prevent late sequelae. Multiple removal methods are recommended, ranging from simple removal to En-bloc resection. In our case, complete removal of the tick was performed with forcep resulting in good clinical outcome.

Case Presentation :

A 10-year-old Malay boy, presented with painless left upper lid swelling for 2 weeks. He denied fever or neurological symptoms. The child was a flood victim and loves outdoor activities involving soil. He denied any insect bite. On examination, an alive tick seen embedded in eyelid margin with surrounding erythema. Ocular and neurological examinations were normal. The tick was gently grasped with tooth forcep and removed in a single piece with no remnant. The site of removal was disinfected with alcohol 70%. Child was given prophylaxis oral and topical antibiotics. Over the week, the wound completely healed with no complications.

Discussion/Conclusion :

With this case report, we would like to raise awareness of lid infestation by ticks particularly in children in rural areas as the diagnosis could be delayed. A forceful removal may increase the risk of toxin release and retained body parts of the tick which can lead to granuloma or abscess formation. Gentle removal without any remnant carries a good clinical outcome.