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Case report: A case of corneal epithelial injury associated with Pthiriasis palpebrarum
1Department of Ophthalmology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Significance:
Phthiriasis palpebrarum is an uncommon infection due to Phthirus pubis inoculating the eyelashes and surrounding tissues of the eye. Because of its rarity, it may be misdiagnosed as blepharitis or conjunctivitis clinically.
Purpose:
This report described a rare case of corneal epithelial injury associated with Phthiriasis palpebrarum.
Case Report:
A 59-year-old woman presented with 1 month history of repeated episodes of itching and irritation symptoms in both eyes. A slit-lamp examination was performed, which revealed mild conjunctival hyperemia and corneal epithelial defects in both eyes. On closer examination, crab-like lice, nits, and red pinpoint excretions were seen on her eyelashes and eyelids bilaterally. Corneal fluorescein staining in both eyes was observed, and tear film break-up time (BUT) in each eye was 2 s. Numerous lice were also found attached to the scalp hair. Therefore, a clinical diagnosis of corneal epithelial injury associated with Pthiriasis palpebrarum was made. For treatment, eyelashes with nits and/or lice were removed mechanically with a fine tweezers. Then, 0.01% Hypochlorous Acid eye wash was used to clean the eyelid margin twice daily. Also, she was prescribed a combination of Vitamin A Palmitate eye gel three times a day and Tobradex® eye ointment once daily. Meanwhile, the patient was provided with suggestions on how to improve personal hygiene and environmental hygiene, including cutting of the scalp hair and the application of 0.01% permethrin rinse. One week later, no evidence of lice and nits of the eyelashes and scalp hair was found, and the patient's symptoms and signs also improved significantly.
Conclusion:
This rare case suggested that the eyelashes of patients presenting with itching and irritation symptoms should be carefully examined with a slit-lamp. Besides removal of the parasites, attention should be paid to the treatment of corneal epithelial injury associated with Pthiriasis palpebrarum.
Insights
Phthiriasis palpebrarum, an eye infection caused by pubic lice (Phthirus pubis), can lead to corneal damage. Early examination of eyelashes is crucial for timely diagnosis and treatment of this rare condition.
Area of Science:
- Ophthalmology
- Parasitology
- Dermatology
Background:
- Phthiriasis palpebrarum is an uncommon eye infection caused by Phthirus pubis, often misdiagnosed as blepharitis or conjunctivitis due to its rarity.
- Corneal epithelial injury is a rare complication associated with this parasitic infestation.
Observation:
- A 59-year-old woman presented with chronic eye itching and irritation.
- Slit-lamp examination revealed conjunctival hyperemia, corneal epithelial defects, and the presence of lice and nits on eyelashes and eyelids.
- Scalp hair also showed lice infestation.
Findings:
- The patient was diagnosed with corneal epithelial injury secondary to Phthiriasis palpebrarum.
- Treatment involved mechanical removal of lice/nits, hypochlorous acid eye wash, Vitamin A eye gel, Tobradex ointment, and permethrin rinse for scalp hair.
- Significant improvement in symptoms and parasite eradication was observed within one week.
Implications:
- This case highlights the importance of thorough eyelash examination in patients with ocular irritation to rule out Phthiriasis palpebrarum.
- Prompt diagnosis and treatment, including parasite removal and management of corneal injury, are essential for favorable outcomes.
- Public health education on hygiene is important to prevent and manage parasitic infections affecting the eyes.
