Phthiriasis palpebrarum in a woman's eyelashes
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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) and multiple nits that have previously mistaken as crust and dandruff were noted on the eyelashes of both eyes under slit-lamp examination.

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 regrowth of eyelashes on 6-month follow-up, both eyelids were still clear.

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, the patient may complain of palpebral pruritus, hyperemia, and is often misdiagnosed as conjunctivitis or blepharitis. 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.

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.