1. Case report
A 52-year-old woman presented with itching of the eyelids, which was previously misdiagnosed as blepharitis. She had a history of kidney transplantation due to chronic kidney disease in 2010 and was taking immunosuppressive and hypertensive medications. Several lice (Phthirus pubis) (Fig. 1) and multiple nits previously mistaken as crust and dandruff were noted on the eyelashes of both eyes under slit lamp examination (Fig. 2). She was referred to the Dermatology department for further evaluation and confirmed the diagnosis of phthiriasis palpebrarum. She removed all eyelashes as most of the topical medications were not established for the safety of ocular mucosal use. The patient was living alone and there was no other patient with phthiriasis palpebrarum who had close contact with this patient. She was free from phthiriasis palpebrarum on follow-up one month later, and after re-growth of eyelashes on 6-month follow-up, both eyelid were still clear. (Fig. 3).
Fig. 1.
Picture of the Phthirus pubis on eyelashes of the patient.
Fig. 2.
Several lice (Phthirus pubis) and multiple nits were found on the eyelashes of right (B.1) and left eye (B.2). Phthirus pubis mainly infested upper eyelashes.
Fig. 3.
Right (C.1) and left (C.2) eyelids free of Phthiriasis palpebrarum 6 months after.
2. Discussion
Generally, Pthirus pubis, the infection source of Phthiriasis palpebrarum, mainly infests the pubic hair but also appears rarely on the eyelashes.1 In such case, patient may complain of palpebral pruritus, hyperemia and is often misdiagnosed as conjunctivitis or blepharitis.1, 2, 3 There are many options of treatment such as trimming of eyelashes, argon laser therapy, cryotherapy, 0.25% physostigmine ointment, 1% gamma benzene hexachloride cream, 1% yellow mercuric oxide ointment, Petrolatum ointment, 20% fluorescein drops, oral ivermectin and etc.1, 2, 3 Among all, mechanical removal is known as the most effective treatment for Phthiriasis palpebrarum.3 As Phthiriasis palpebrarum is generally associated with poor hygiene and sexual contact, family members and sexual partners are recommended for appropriated examination and education.1,3
3. Conclusion
Ophthalmologists should carefully examine the eyelids in patients with suspected blepharitis and conjunctivitis without improvement despite treatment for differential diagnosis of Phthiriasis palpebrarum. Mechanical removal of the infested hairs is an effective treatment.
Funding
No funding or grant support
Authorship
All authors attest that they meet the current ICMJE criteria for Authorship.
CRediT authorship contribution statement
Eunhae Shin: Validation, Formal analysis, Investigation, Data curation, Writing - original draft, Visualization. Tae-Young Chung: Methodology, Writing - review & editing, Project administration. Dong Hui Lim: Conceptualization, Formal analysis, Resources, Writing - review & editing, Supervision.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgments
There is no any other contributions to present work.
References
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