Chronic conjunctivitis related to phthiriasis palpebrarum

Abstract

We describe a case of chronic conjunctivitis related to phthiriasis palpebrarum. A 36 year-old female presented with gradual pruritus and painless ocular hyperaemia over the previous 3 months. On examination, nasal pterygium, conjunctival hyperaemia, oedema, and mild hypertrophy of the palpebral margin were observed. A slit-lamp examination revealed numerous creamy oval structures approximately 1 mm in diameter localised in the middle area of the lashes, and bloody crusts and a semi-transparent deposit were present in the superior palpebral margin. Based on the observation of numerous nits at the base of the eyelashes and the ectoparasite in the palpebral margin, a diagnosis of phthiriasis palpebrarum was made. The patient was referred to an infectologist for evaluation of other sexually transmitted diseases and examination of other body areas. She was successfully treated with oral ivermectin, shampoo for ciliary hygiene and artificial tears. Other recommendations to avoid re-infestation were made, such as changing, washing and sterilising clothes, towels and sheets daily. This report emphasizes the importance of the correct diagnosis and management of this disease, considered as sexually transmitted.

Phthiriasis palpebrarum in a woman's 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.…”

“… 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.…”

Phthiriasis palpebrarum: an uncommon cause of ocular irritation

“…This is a distinct species from hair or body lice. 1 it is typically transmitted sexually from the pubic region to the eyelashes; therefore, sensitive history taking that includes a social and sexual history is necessary, and full examination of the body is indicated. Contact tracing and screening for other venereal infections may also be indicated.…”

Phthiriasis palpebrarum: A case of eyelash infestation with Pthirus pubis

“…Phthiriasis palpebrarum is also occasionally misdiagnosed as common blepharitis (16). Clinically, this disease is typically not considered, in particular when ocular symptoms are not obvious (17). To avoid this, it is recommended that eyelids and eyelashes are carefully examined by slit lamp to avoid misdiagnosis (18).…”