Phthiriasis palpebrarum misdiagnosed as blepharitis

Abstract

A 40-year-old woman presented at Sankara Eye Hospital Ludhiana with a complaint of itching in both eyes for the previous month. Before presenting at our outpatient clinic, she had been diagnosed and treated elsewhere, without improvement, for blepharitis. On examination, visual acuity was 20/20 in both eyes. Slit lamp examination revealed red, crusty eyelid margins and mild conjunctival hyperemia, with lice (Pthirus pubis) moving over the eyelashes, along with nits at the base. The patient was diagnosed as a case of bilateral phthiriasis palpebrarum. There was no history of similar complaints in other family members, overcrowding, or sexual contact with a louse infested individual. General examination did not reveal lice anywhere else on the body. The patient was treated with topical application of petrolatum jelly over the eyelashes with thorough soap-water rinsing, followed by the mechanical removal of all parasites. Local application of antibiotic eye ointment and 1% permethrin was advised. Systemic combination albendazole 400 mg with ivermectin 12 mg combination was prescribed for 5 days.