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Ixodes tick infestation of the eyelid of a child
CORRESPONDENCE Ixodes tick infestation of the eyelid of a child
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here are few reports in the literature of tick infestation of ocular tissues. Here we present the first documented case, notable for its occurrence in an urban setting, of Ixodes infestation of the eyelid of a child in Singapore. Ticks are known vectors of certain infectious diseases; complete removal is important to prevent late sequelae such as granuloma and abscess formation. An 11-year-old girl of Japanese origin developed right upper eyelid swelling and pain for several days. There was no history of travel or known exposure to animals. The child lived and attended school in the urban environment of a city-centre location in Singapore. The child’s mother had removed an organism from the affected lid and another identical organism from the chest (Fig. 1, top). On examination, the patient’s visual acuity was 6/9 on the right and 6/6 on the left. There was an injected area at the right upper lid margin measuring 2 mm across (Fig. 1, bottom). The conjunctiva was mildly injected; the anterior segment was otherwise normal. There were no residual tick parts on the eyelid or chest. She was systemically well. She was treated with lid toilet, irrigation, and topical 0.3% gatifloxacin (Zymar, Allergan Inc., Irvine, Calif.) 4 times daily to the affected eye. The lid healed after 2 weeks without scarring. Examination of the organisms revealed that they belonged to the genus Ixodes. Two months later, the patient experienced further pain and swelling at the same location. A chalazion was found and treated effectively with incision and curettage. Tick infestation of ocular tissues is a rare occurrence. There are few reported cases of tick bites to the conjunctiva.1,2 There are scant reports of tick infestation of the eyelid, one reported case involving the eyelid margin.3,4 Ticks are acarine ectoparasites of the genus Ixodes that are adapted to blood sucking to obtain nutrition from other animals. They have been implicated as vectors in the transmission of infectious diseases such as Lyme disease and Crimean–Congo hemorrhagic fever.5 A number of methods of removal have been
CAN J OPHTHALMOL—VOL. 41, NO. 6, 2006
Fig. 1—Top: Ventral aspect of the tick recovered from patient’s eyelid. Bottom: Affected eyelid shows erythema of the meibomian gland orifice after removal of the tick.
described, including manual removal with the aid of topical chemical agents and en bloc removal with excision of surrounding tissue.2–4 All methods aim for complete removal of tick parts from host tissue to prevent late complications or sequelae such as granuloma or inflammatory and infectious skin abscess formation. In the present case, the source of the tick was difficult to identify. The child and her family resided in an apartment building in the main shopping and business district. There was no history of recent travel
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or exposure to farmland and wild or domestic animals at home or at school. The ophthalmologist should maintain an index of suspicion that tick infestation of the eyelid may present in urban locations. Careful examination and compete removal are recommended to ensure an uneventful recovery. It is also important to exclude tick infestation on other parts of the body. Mandeep Singh, MRCSEd NUH Eye Surgery Centre National University Hospital, Singapore [email protected] Ponnampalam Gopalakrishnakone, FAMS, PhD
Department of Anatomy Yong Loo Lin School of Medicine National University of Singapore, Singapore Ronald L.S. Yeoh, FRCOphth Eye Clinic Singapura, Singapore
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CAN J OPHTHALMOL—VOL. 41, NO. 6, 2006
REFERENCES 1. Bode D, Speicher P, Harlan H. A seed tick infestation of the conjunctiva: Amblyomma americanum larva. Ann Ophthalmol 1987;19:63–4. 2. Jensen LA, Snow RL, Clifford CM. Spinose ear tick, Otobius megnini, attached to the conjunctiva of a child’s eye (letter). J Parasitol 1982;68:528. 3. McLeod BK. Sheep tick in the eyelid. Br J Ophthalmol 1986;70:75–6. 4. Samaha A, Green WR, Traboulsi EI, Ma’luf R. Tick infestation of the eyelid. Am J Ophthalmol 1998;125:263–4. 5. Winterkorn JMS. Lyme disease: neurologic and ophthalmic manifestations. Surv Ophthalmol 1990;35:191–204.
T
here are few reports in the literature of tick infestation of ocular tissues. Here we present the first documented case, notable for its occurrence in an urban setting, of Ixodes infestation of the eyelid of a child in Singapore. Ticks are known vectors of certain infectious diseases; complete removal is important to prevent late sequelae such as granuloma and abscess formation. An 11-year-old girl of Japanese origin developed right upper eyelid swelling and pain for several days. There was no history of travel or known exposure to animals. The child lived and attended school in the urban environment of a city-centre location in Singapore. The child’s mother had removed an organism from the affected lid and another identical organism from the chest (Fig. 1, top). On examination, the patient’s visual acuity was 6/9 on the right and 6/6 on the left. There was an injected area at the right upper lid margin measuring 2 mm across (Fig. 1, bottom). The conjunctiva was mildly injected; the anterior segment was otherwise normal. There were no residual tick parts on the eyelid or chest. She was systemically well. She was treated with lid toilet, irrigation, and topical 0.3% gatifloxacin (Zymar, Allergan Inc., Irvine, Calif.) 4 times daily to the affected eye. The lid healed after 2 weeks without scarring. Examination of the organisms revealed that they belonged to the genus Ixodes. Two months later, the patient experienced further pain and swelling at the same location. A chalazion was found and treated effectively with incision and curettage. Tick infestation of ocular tissues is a rare occurrence. There are few reported cases of tick bites to the conjunctiva.1,2 There are scant reports of tick infestation of the eyelid, one reported case involving the eyelid margin.3,4 Ticks are acarine ectoparasites of the genus Ixodes that are adapted to blood sucking to obtain nutrition from other animals. They have been implicated as vectors in the transmission of infectious diseases such as Lyme disease and Crimean–Congo hemorrhagic fever.5 A number of methods of removal have been
CAN J OPHTHALMOL—VOL. 41, NO. 6, 2006
Fig. 1—Top: Ventral aspect of the tick recovered from patient’s eyelid. Bottom: Affected eyelid shows erythema of the meibomian gland orifice after removal of the tick.
described, including manual removal with the aid of topical chemical agents and en bloc removal with excision of surrounding tissue.2–4 All methods aim for complete removal of tick parts from host tissue to prevent late complications or sequelae such as granuloma or inflammatory and infectious skin abscess formation. In the present case, the source of the tick was difficult to identify. The child and her family resided in an apartment building in the main shopping and business district. There was no history of recent travel
783
Correspondence
or exposure to farmland and wild or domestic animals at home or at school. The ophthalmologist should maintain an index of suspicion that tick infestation of the eyelid may present in urban locations. Careful examination and compete removal are recommended to ensure an uneventful recovery. It is also important to exclude tick infestation on other parts of the body. Mandeep Singh, MRCSEd NUH Eye Surgery Centre National University Hospital, Singapore [email protected] Ponnampalam Gopalakrishnakone, FAMS, PhD
Department of Anatomy Yong Loo Lin School of Medicine National University of Singapore, Singapore Ronald L.S. Yeoh, FRCOphth Eye Clinic Singapura, Singapore
784
CAN J OPHTHALMOL—VOL. 41, NO. 6, 2006
REFERENCES 1. Bode D, Speicher P, Harlan H. A seed tick infestation of the conjunctiva: Amblyomma americanum larva. Ann Ophthalmol 1987;19:63–4. 2. Jensen LA, Snow RL, Clifford CM. Spinose ear tick, Otobius megnini, attached to the conjunctiva of a child’s eye (letter). J Parasitol 1982;68:528. 3. McLeod BK. Sheep tick in the eyelid. Br J Ophthalmol 1986;70:75–6. 4. Samaha A, Green WR, Traboulsi EI, Ma’luf R. Tick infestation of the eyelid. Am J Ophthalmol 1998;125:263–4. 5. Winterkorn JMS. Lyme disease: neurologic and ophthalmic manifestations. Surv Ophthalmol 1990;35:191–204.