A 4-year-old girl presented with a 2-week history of itchy red eyes. She had been diagnosed with blepharitis and had been treated with antibiotic and steroid eye drops. Slit-lamp examination revealed reddish-brown crusts at the eyelid margins and conjunctival hyperemia (Fig. 1A). Several mobile semitransparent lice and nits were present on the eyelashes and the patient was diagnosed with phthiriasis palpebrarum (Fig. 1B and video upon request). The two siblings of the girl, a 5-year-old boy and a 11-month-old girl, also had several crab lice and ovoid nits on their eyelashes. Screening of all family members showed that the father was infested with phthiriasis pubis. Referral of the children to a child psychiatrist revealed no signs of abuse. The children were treated with topical 1% yellow mercuric oxide ointment four times daily, and the symptoms resolved after 2 months.
Figure 1:
(A) The eyelid margin appears reddish and irritated with several lice (arrowheads) and nits (arrow) anchored to the eyelashes. (B) Phthirus pubis (arrowhead) hanging from the eyelashes.
(A) The eyelid margin appears reddish and irritated with several lice (arrowheads) and nits (arrow) anchored to the eyelashes. (B) Phthirus pubis (arrowhead) hanging from the eyelashes.Phthiriasis palpebrarum is a rare cause of blepharoconjunctivitis usually associated with crowded conditions and poor hygiene [1]. In children, eyelashes are the most common site of infestation, because of the lack of terminal hairs in other body regions [2]. Children are usually infected through contact with infected adults, hence, child abuse should be carefully investigated [3]. Clinical characteristics of phthiriasis palpebrarum range from mild irritation and pruritus of the eyelids, to blepharitis, marginal keratitis and persistent conjunctival inflammation. Phthiriasis palpebrarum may be misdiagnosed as atopic dermatitis or allergic conjunctivitis, because the lice are sometimes difficult to identify due to their semitransparency and deep burrowing in the lid margin [2]. Slit-lamp examination will indicate the correct diagnosis. Manual removal with forceps is the simplest treatment in adults. In children, the use of yellow mercuric oxide ointment or petroleum jelly is an effective alternative [4, 5]. Reinfestation should be prevented by proper hygiene, sterilization of clothing and bedding and treatment of all family members.Click here for additional data file.Click here for additional data file.
Figure 1: