Journal of Optometry and Ophthalmology An Open Access Journal

Phthriasis Palpebrarum Simulating Blepharitis and Eczema in a Child

Mandeep Tomar1*, Gaurav Sharma2, Shaloo Negi3 and Deepanshu Dhiman4

1Department of Ophthalmology, Medical Officer, DR.YSPGMC Nahan,HP, India 2Department of Ophthalmology,Assistant Professor,DR. RPGMC Tanda HP, India 3Department of Ophthalmology, Medical Officer, Reckong Pio Kinnour HP, India 4Department of Ophthalmology,Senior resident Anaesthesia PGIMER Chandigarh.

*Corresponding Author: Mandeep Tomar, Department of Ophthalmology, Medical Officer DR.YSPGMC Nahan, HP, India

Received Date: 10-08-2019; Accepted Date: 11-21-2019; Published Date:11-25-2019

Copyright© 2019 by Tomar M, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Keywords

Phthiriasis Palpevrarum; Crab Louse; Chronic Blepharitis; Eczema Introduction

Phthiriasis palpebrarum is an eyelid infestation which is caused by Phthiriasis pubis, also known as crab louse [1]. These lice are primarily found in pubic hair but can also present on the hair of the abdomen, thighs and the axilla. Eyebrows and eyelashes infestation may occasionally be found [2]. Infestation may be found in any hair-bearing area and lice may be transferred from one of the hairy site to another area [3]. Primarily, routes of infestation are interaction of parent with child or through sexual contact,but transfer may occur through fomite borne route also [4]. Worldwide 1-2% of the human population is affected [5] and poor hygiene and overcrowding are generally associated factors [6]. Commonly, sexually active patients from 15 to 45 years of age infest this condition and a misdiagnosis of blepharitis and eczema is common in these patients[7-9]. We present a case of Phthiriasis palpebrarum in a 7 years old child simulating appearance of chronic blepharitis and eczema. Case report

A 7 year old boy presented to us with complaints of severe itching with intermittent watering from both eyes since last 6 months.Parents gave history of use of antiallergic eye drops prescribed from some general practitioner with temporary relief and recurrence of symptoms. Visual acuity was 6/6 bilaterally with normal ocular movements and normal papillary

Tomar M| Volume 1; Issue 1 (2019) | Mapsci-JOO-1-002| Case Report 1 Citation: Tomar M, Sharma G, Negi S, Dhiman D. Phthriasis Palpebrarum Simulating Blepharitis and Eczema in a Child. J Opto Ophth. 2019;1:1-7.

reactions. On diffuse torchlight examination(Figure 1 and 6), scales and crusting was noted over bilateral upper eyelids.On slit lamp examination (Figures 2,3, 5and7)multiple crab lice were foundanchored to the eyelashes and eyelid skin firmly on bilateral upper eyelids and also lower eyelid margin in right eye.Also,3-4 nits (eggs of lice) (Figure 4) were noted in upper eyelashes in right eye. A diagnosis of phthriasis palpebrarum was made. Treatment consisted of mechanical removal of lice under slit lamp examination, application of petroleum jelly over eyelid margins, tablet Ivermectin 3mg stat followed by a repeat dose after 1 week and also 1% permethrin shampoo for local application. After 1 week of follow up, child was free of ocular symptoms and no louse were detected on slit lamp examination.

Figure 1: On torch light examination showing scales with crusting in both upper eyelids.

Figures 2: Slit lamp examination showing phthirus pubis lice in upper eyelid margin anchored with eyelashes OD.

Tomar M| Volume 1; Issue 1 (2019) | Mapsci-JOO-1-002| Case Report 2 Citation: Tomar M, Sharma G, Negi S, Dhiman D. Phthriasis Palpebrarum Simulating Blepharitis and Eczema in a Child. J Opto Ophth. 2019;1:1-7.

Figure 3: Slit lamp examination showing phthirus pubis lice in upper eyelid margin anchored with eyelashes OD.

Figure 4:Showing 3-4 nits(eggs) in upper eyelashes OD.

Tomar M| Volume 1; Issue 1 (2019) | Mapsci-JOO-1-002| Case Report 3 Citation: Tomar M, Sharma G, Negi S, Dhiman D. Phthriasis Palpebrarum Simulating Blepharitis and Eczema in a Child. J Opto Ophth. 2019;1:1-7.

Figure 5: Anchored lice in lower eyelid margin OD.

Figure 6: Diffuse torch light examination showing crust with louse attached at upper eyelid margin.

Tomar M| Volume 1; Issue 1 (2019) | Mapsci-JOO-1-002| Case Report 4 Citation: Tomar M, Sharma G, Negi S, Dhiman D. Phthriasis Palpebrarum Simulating Blepharitis and Eczema in a Child. J Opto Ophth. 2019;1:1-7.

Figure 7: Showing lice inupper eyelid margin OS.

Discussion

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Hair of the axilla, chest, scalp, pubis and rarely, eyebrows and eyelashes are infested by adult lice. Phthirus pubis is most commonly responsible for infestation of eyebrows or eyelashes, which is transferred by hand contact from the genital area to the eye. Palpebral involvement in isolated form has also been described sometimes [10-12]. Patients with poor personal hygiene typically manifest phthiriasis palpebrarum and are uncommon in developed countries [13]. Symptoms are similar to blepharo conjunctivitis so diagnosis can be missed easily. Pthirus pubis lives in pubic hairprimarily [14] but can be found in the hair of the axilla, chest, eyebrows and eyelashes in case of heavy lice load [17]. This disease is not considered, in particular when ocular symptoms are not obvious [18,19].So, it is recommended that slit lamp examination ofeyelids and eyelashes should be done carefully to avoid misdiagnosis[20]. Pubic lice can ambulate and travel from groin to eyelashes or other hairy areas by themselves unlike in adults where transfer is common by hands and less common by infected clothing or bed linen. In case of children, eyelashes are the most common site of lice infestation[22,23]. Transmission by bed linens and infected clothing is less likely and may be a sign of sexual abuse, and the possibility of abuse should be investigated [21-24]. In our case, possibility of sexual abuse was ruled out by thorough and detailed enquiry from the parents.

Recommended treatment options for phthiriasis palpebrarum are mechanical removal with forceps, plucking ortrimming of eye lashes [24], traumatic amputation [22], cryotherapy [25], argon laser photocoagulation, fluorescein eye drops 20% [29], physostigmine0.25% [30], lindane 1% , petroleum jelly [31], yellow mercuric oxide ointment 1% [28] malathion drops 1% or malathion shampoo1%,1% gamma-benzenehexachloride cream, pyrethrin ointment [21], permethrin1%cream [22], kerosene [26], oral ivermectin [24] and pilocarpine gel 4% [21,27]. Manual removal of nits after treatment with any product is recommended as none of the pediculicides are 100% ovicidal. Conclusion

Phthiriasis palpebrarum may present as and may mimic blepharitis. So, slit lamp examination of eyelids and eyelashes should be done carefully to avoid misdiagnosis in cases of blepharitis. Mechanical removal is the best effective treatment option for phthiriasis palpebrarum but patient should be kept for regular follow up to look for any residual lice and nits. References

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