Phthiriasis palpebrarum: A systematic review and illustrative case presentation

To investigate the clinical features, diagnostic methods, and treatment modalities of Phthiriasis palpebrarum (PP). We conducted a systematic review of case reports and case series of PP by searching MEDLINE, Embase, and ISI Web of Knowledge databases. Demographic and clinical features were extracted and reviewed. Furthermore, a case of Phthirus pubis infestation in the eyelashes of a young boy is also described. A total of 88 records involving 110 cases were included in the final analysis. The median age at admission was 21 years, with an equal proportion of males and females. The common clinical symptoms were itching (81.7%), irritation (26.6%), and redness (17.4%), with 67% of cases exhibiting bilateral involvement. The median duration of symptoms at presentation was 4 weeks. Approximately one-third of patients were misdiagnosed and unsuccessfully treated before presentation. Complications such as conjunctivitis and keratitis occurred in 30 cases (27.5%) and 4 cases (3.7%), respectively. Slit lamp examination or dermoscopy with light microscopy were the main diagnostic modalities. A combination of treatment modalities was employed in 69.7% of the cases. The main nonpharmacological therapies included mechanical removal of lice and nits and trimming of eyelashes. Commonly used pharmacological therapies were topical petrolatum jelly and topical antibiotics/corticosteroids. Over a median follow-up of 2 weeks, symptoms and lice/nits were resolved in most patients. Ophthalmologists should be aware of the possibility of PP in patients presenting with ocular itching.