This case series describes 3 cases of tick infestation of the eyelid that were seen at AIMS Kochi, India. In the first two cases, the ticks were identified as engorged adult female brown dog ticks (Rhipicephalus sanguineus). The third case was identified as a Hemophysalis species tick. Ticks were removed intact from the eyelids using blunt forceps. Identification of the ticks was later confirmed. Rhipicephalus sanguineus and Hemophysalis species ticks are common parasites that can infest humans and are vectors for several diseases. Ophthalmologists should be aware of potential tick-borne illnesses that may result from eye or skin infestations.

1. Tick Infestation Of The Eyelid: A Case
Series.
Lavanya Livingston1, Nithya Anilkumar1, Sujithra H2, Poornima
Baby1, Kutumbaka Akhila2, Balakrishnan Natarajan3, Raghunandanan
Varma4, Girija Rajagopal1, Anil Kumar1.
Department of Microbiology1 and Ophthalmology2, AIMS Kochi, Centre For
Disease Control, Bangalore3, Department Of Ophthalmology, Krishna Hospital
Kochi4

2. INTRODUCTION
• Ticks are the most common hematophagous arthropods that parasitize humans. Rhipicephalus sanguineus
and Hemophysalis species are parasites of dog and occasionally infests other hosts including humans.
Rhipicephalus sanguineus is associated with the transmission of Rocky mountain spotted fever caused by
Rickettsia rickettsii. Hemophysalis species transmit diseases like tick borne encephalitis, Borreliosis, Q
fever, Tularaemia, Rickettsiosis, Babesiosis, Anaplasmosis and Crimean Congo haemorrhagic fever. Some
major vectors seen in India are Hemophysalis spinigera, Hemophysalis turturis, Rhipicephalus sanguineus,
Hyalomma anatolicum .[1]

3. METHODOLOGY
• Case 1
A 54 year old female presented to the ophthalmology
OPD of AIMS, Kochi with complaints of severe pain,
watering and lesions near the middle canthus of the
right eye for three days. She gave a past history of
migraine and was on medication since 3 years. On
examination a parasite was seen near the middle
canthus of right eye with severe tenderness, mild
discharge and palpable periauricular lymph nodes .
After administration of local
anesthetic (lidocaine infiltration) parasite was removed
using forceps and sent to microbiology lab for
identification. The parasite was transferred from
container to a Petri dish and inspected.(fig: 1)
(fig :1)

4. • Case 2
A 57 year old male presented to the ophthalmology OPD
with complaints of a rapidly growing tumour on his lower
right eyelid since past two weeks. The patient had a pet
dog at home.
On slit lamp examination a light brown smooth glistening
rounded nodule was seen attached to the lower right eye
lid. Surrounding areas were normal without tenderness.
Macroscopic examination of mass was not suggestive of
tumour. (fig:2)
The tick was grasped close to the skin
surface and pulled upwards without twisting or jerking it.
It was removed intact without breaking its mouth parts
and sent to microbiology lab for identification.
(fig:2)

5. • Case 3.
A 51 year old male patient presented to the
ophthalmology OPD of AIMS Kochi with complaints
of small nodular mass, severe pain, and bloody
discharge in the lateral canthus of right eye of 5 days
duration.
On examination swelling was present on the
right lower lid with tick in-situ. (fig:3)
It was removed using blunt forceps
under anesthesia and sent to microbiology lab for
identification.
(fig:3)

6. RESULTS
• Under microbiological examination first two
cases were presumptively identified as engorged
adult female (males don’t enlarge on feeding) of
the reddish brown dog tick (Rhipicephalus
sanguineus).(fig:4)
(fig:4)

7. • Third case was identified as Hemophysalis species.(fig:5)
dorsal surface ventral surface
(fig:5)

8. • Further confirmation was made by College Of Veterinary And Animal Sciences, Mannuthy.

9. DISCUSSION
• Ticks have been recognised as human parasitises for thousands of years and they are implicated as vectors of many
human diseases. They belong to two major families Ixodidae (hard ticks) and Argasidae (soft ticks ). Rhipicephalus
and Haemophysalis belong to the Ixodidae family. They have three-host life cycle, with each feeding stage of the
tick (larva, nymph and adult) having single host. Dogs are the main host of Rh.sanguineus in both urban and rural
areas.[2]
• Brown dog tick is particularly associated with transmission of Rocky Mountain Fever (RMSF) a life threatening
tick borne disease caused by Ricketssia ricketsii.
• In India, important Hemophysalis species are H.spinigera, H.turturis, H.bispinosa, H.cuspidata. 53% of these
species were found on dogs. They can transmit many serious diseases to humans including Kyasanur forest disease
and Crimean Congo hemorrhagic fever.[1]
• Most of the tick-borne diseases can have similar signs and symptoms like fever, chills, muscle aches, joint pains
and rashes. In Rocky Mountain spotted fever the rash varies greatly from person to person in appearance.[2]

10. Identification of ticks
Rhipicephalus sanguineus . (Brown dog tick)
 5mm long
 Eyes present
 Short stout mouth parts (fig:6)
• Hemophysalis species.
 3mm long
 Eyes absent
 Short and conical palps (fig:7)

11. (fig:6) (Fig:7)

12. • Differentials for Brown dog tick.[2]
1. American dog tick (Dermacentor variabilis)
2. Lone star tick (Amblyomma americanum)
3. Deer tick (Ixodes scapularis)
• Dermacentor variabilis
(American dog tick)
– 5mm long
– Dark brown
– Light wavy reticulations on its back(fig:8)
(fig:8)

13. • Ixodes scapularis (Deer tick)
• small tick about 2-3 mm in length
• long mouthparts
• off-white or reddish when fed
• black legs (fig:9)
Amblyomma americanum (Lone star tick )
• 5 mm in length or less with
• long mouthparts
• light reddish-brown
• central white spot on the back (adults)(fig:10)
(fig:9)
(fig:10)

14. CONCLUSION
• Many of the newly emerging and re-emerging diseases of zoonotic origin are transmitted by
ticks. Tick borne diseases are prevalent only in specific areas where the favourable
environmental conditions exists for individual tick species. Ophthalmologists should be aware
of possible systemic diseases like Spotted fever, Lyme disease, Rickettsiosis, Ehrlichiosis,
Tularemia and Q fever that may arise after tick infestation of the eye and adjacent structures.[1]
Mechanical extraction of the whole tick using blunt forceps is the safe and effective treatment
options. The patient should be monitored with the clinical observation and follow-up for tick
borne disease.[4]
• 70% of Indian population are involved in agriculture and farmers keep animals for various farm
operations.[1] It is necessary to create an awareness about tick borne infestations among farmers
and other animal handlers. Treatment of clothes and gears with 0.5% permethrin and showering
within two hours of coming indoors can reduce the risk of infection.[4]

15. REFERENCES
1. Balakrishnan N.Current Scenario of Tick Borne Diseases in India - A Review. Journal Of Communicable
Diseases. 2017; 49(2) : 6-13.
2. Philippe Parola, Didier Raoult, Ticks and Tickborne Bacterial Diseases in Humans:
An Emerging Infectious Threat, Clinical Infectious Diseases, Volume 32, Issue 6, 15 March 2001.
3. Saxena, Vijay & Kumar, Kaushal & Rajagopal , R.(1985). Vertical distribution of ticks of domestic
animals in Nilgiri hills (Tamil Nadu) .The Journal Of Communicable Diseases.16.323-5.
4. Centers For Disease Control And Prevention, National Center for Emerging and Zoonotic Infectious
Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 30 September 2019.