Meenakshi Wadhwani¹* and Shubhangi Kursange²

¹Assistant Professor and Incharge, Chacha Nehru Bal Chikitsalya, New Delhi, India
²Senior Resident, Chacha Nehru Bal Chikitsalya, New Delhi, India

*Corresponding Author: Meenakshi Wadhwani, Assistant Professor and Incharge, Chacha Nehru Bal Chikitsalya, New Delhi, India.

Received: February 17, 2021; Published: March 10, 2021

  Phthiriasis palpebrarum is a rare eyelid infestation caused by Phthiriasis pubis or Crab lice. These lice have a predominant liking for axilla, groin, thighs but occasionally may invade eyelashes or eyelids [1]. The main common route for transfer is sexual contact followed by areas with history of overcrowding and poor hygiene. Phthiriasis palpebrarum infestation affects 1 to 2% of the human population worldwide [2]. There is history of around 30% of the cases associated with another sexually transmitted diseases. We hereby, report the case of unusual presentation of this infestation in a 5 year old child.

  A 5 year old child presented to ophthalmology department of a tertiary care pediatric hospital with history of itching and insect crawling on eye for past two days. On ocular examination the visual acuity was 6/6 in both eyes (OU). Slit lamp examination, revealed matted eyelashes covered with around 10 adult crab lice along with mild hyperaemia of right upper lid (OD) margin. Rest of the examination of both anterior and posterior segment for OU was unremarkable. Some of these lice were removed mechanically using forceps under topical anaesthesia. Some of the lashes were cut as it was difficult to remove the ova. The parents were advised to treat the child’s personal belongings like clothes, towel and bedsheet with disinfectant and warm water. The microbiological examination confirmed the presence of Phthiriasis pubis. The child was advised to get the shaving of head and was started on petrolatum jelly (Vaseline) twice a day for local application on OD and to clean scalp with permethrin shampoo once a day for two weeks. Petrolatum jelly is known to suffocate and immobilise the lice along with ovicidal activity, permethrin is known to be affective both on lice and hatched eggs but not unhatched eggs. It has 100% pediculicide and 70% ovicidal activity [1]. The parents denied any history of sexual abuse although there was a history of overcrowding and lack of hygiene and the child belonged to lower socioeconomic status. The child was referred to dermatology and otorhinolaryngology department for further investigation and management. At two weeks follow up, the lice has completely subsided. In conclusion, this case highlights the importance of slit lamp examination in every case of itching as these lice may sometimes be treated as blepharitis due to misconception of squames present on the eye lashes.

Figure 1 (a): Slit lamp examination showing adult crab lice anchored to eye lashes of a 5 year old child, 1 (b): Follow-up after two weeks of treatment.