Phthiriasis Palpebrarum in A Psychiatric Patient.

A 20-year-old man presented with irritation and itching in both eyes for past 1 month. He was on psychiatric medications and was living in an overcrowded psychiatric rehabilitation center for a 1 year. Slit lamp examination revealed several crab lice (Figure 1, arrow mark) along with their nits (Figure 1, star marks) on the eyelashes of both the eyes. A diagnosis of phthiriasis palpebrarum was made and the patient was treated with topical application of 20% fluorescein solution followed by mechanical removal of all lice and nits.[1] He was also prescribed ciprofloxacin eye ointment for 2 weeks. After 2 weeks, his symptoms completely subsided and slit lamp examination revealed absence of any lice or nits. Phthiriasis palpebrarum is often missed due to deep attachment of the lice in the lid margin and hence is often misdiagnosed as allergic conjunctivitis or blepharitis.[2] Phthiriasis pubis with itching in perianal and pubic region is a common association of this condition and sexual contact or close contact with an already infested patient has been described as the most common mode of transmission. However, our case did not complain of itching in perianal and pubic region and on inspection there were no louse or nits in his pubic region.[23]

Figure 1

Adult louse (arrow mark) and nits (star marks) of phthiriasis palpebrarum on the eyelashes of the patient

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