A “Ticked-Off” eyelid – rare ophthalmic manifestation

Two patients presented 1 month apart with similar complaints of sudden onset nodule on eyelid associated with itching, redness, and pain. Upon slit lamp examination, live Ixodes tick was seen embedded near the canthus with surrounding erythema [Fig. 1]. Complete removal of tick was done with forceps on slit lamp. Ocular complications of tick infestation include blepharitis, granuloma formation, conjunctivitis, keratitis, uveitis, and vasculitis.[1,2] A high index of suspicion and early and complete removal of tick are mandatory to prevent ocular and systemic complications.[3] After removal, careful examination should be done to ensure complete removal of all parts of the tick.[4]Figure 1: (a and b) showing patient 1 with tick embedded near medial canthus with localized edema on torch examination and diffuse slit lamp examination. (c and d) showing the same species of tick embedded at lateral canthus with ecchymosis on torch light examination and slit lamp examinationAuthor’s contributions All authors have contributed significantly to the case, including conceptualization, image acquisition, and manuscript preparation. All authors have reviewed and approved the final version of the manuscript and affirm that it represents honest and original work. Declaration of patient consent The author 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 this 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 The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.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.