Human palpebral infestation by mysterious laying eggs: A case report

Abstract

AbstractPurpose: Tick infestation of ocular tissues is a rare occurrence. Ticks are ectoparasites which feed with animal blood. They are vectors of several diseases, as Lyme borreliosis, Crimean‐Congo hemorrhagic fever, typhus, Q fever,... We present the case of a tick infestation of the eyelid of a child.Methods: A 7‐year‐old girl presented for itchy eyelid, pain, and sensation of moving worms in the left superior eyelid. Her mother reported they just came back from vacation in Thailand, 3 days before. Examination of the left upper lid revealed one large moving ectoparasite with a group of eggs, laid below the upper eyelid. Some eggs had hatched, and small ticks were moving on and under the upper eyelid. Given the age of the girl and the nature of the infestation, it was impossible to remove the parasite and eggs at slit lamp. An appointment was settled the next day to remove them in operating room. The following day, the parasite detached itself from the eyelid. The sample was sent to a specialized center in tropical species. Careful examination revealed a slightly swollen palpebral conjunctiva towards the area where the tick was. Physical examination did not reveal other ectoparasite and treatment with Tobramycine was initiated as a precaution. The girl was sent to infectious diseases specialist to perform serologic tests.Results: The ectoparasite was identified as amblyomma sp tick. A shell insect infestation on the eyelid is not common at all. The cases found in literature describe cases of ticks feeding on the eyelid, but none of them reports the presence of eggs around the large ectoparasite (1). We supposed that the parasite stayed long enough to lay its eggs.Conclusions: Ophthalmologists are rarely confronted with ectoparasites and should be aware that removing the whole tick from the affected tissue is of important in the prevention of tickborne diseases and possible local complications (2). Serologic tests for tick‐borne diseases should be done and the patient monitored with clinical observation and follow‐up.