Eyelid Infestation: A Case Report of Atypical Phthiriasis Palpebrarum

Phthiriasis palpebrarum is a rare parasitosis of the eyelashes caused by Phthirus pubis. This report describes an atypical case of this disease. A 72-year-old female patient suffered prolonged symptoms of severe left eye pruritus for 18 months, refractory to conventional eyelid hygienic measures, and anti-histaminic and corticosteroid medications. Slit-lamp examination showed multiple translucent oval structures adherent to the upper eyelashes, and 18 crab-like lice, which were mechanically removed and characterized as Phthirus pubis. Treatment was started with corticosteroid and antibiotic ointment, vaseline, and Blephademodex® wipes (Laboratoires Théa, Auvergne-Rhone-Alpes, France). After 2 weeks, all symptoms had subsided completely. Although rare, phthiriasis palpebrarum may be easily confused with frequent palpebral pathologies like blepharitis. A careful slit-lamp examination is central for proper evaluation and diagnosis. Mechanical removal of the lice is the most effective treatment but should be complemented by topical and/or systemic treatment. This report presented an atypical case of this disease.