|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 6 | Page : 817-818
A rare cause of blepharoconjunctivitis: Phthiriasis palpebrarum
Ceyda Baskan, Rahmi Duman, Mehmet Balci, Sibel Ozdogan
Ankara Oncology Research and Training Hospital, Turkey
|Date of Web Publication||11-Nov-2014|
Camlitepe Mah, Kibris Caddesi 9/4, Cankaya, Ankara
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Baskan C, Duman R, Balci M, Ozdogan S. A rare cause of blepharoconjunctivitis: Phthiriasis palpebrarum. Niger J Clin Pract 2014;17:817-8
Having read with interest the research article by Yi et al.,  we feel the need to share some of our observations. The paper presents a rare cause of blepharoconjunctivitis that is often unrecognized because of the louse's semi-transparent body and its deep burrowing into the eyelid margin.
The paper however raises concern about the misdiagnosis of phthiriasis palpebrarum as bacterial, viral, or allergic conjunctivitis or seborrheic dermatitis in the study. We dare to say that this can be easily overlooked due to the infrequency of phthiriasis palpebrarum.
We came across a patient that made us to think a diagnosis of phthiriasis palpebrarum in our clinic. This case consulted us from another hospital with a suspicious diagnosis of bacterial blepharoconjunctivitis because the patient's itchiness had continued to exacerbate after anti-bacterial treatment.
A 63-year-old female patient referred to ophthalmology service of our hospital with a complaint of left eye itch for about 3 weeks. In fact, she had an uncommon infestation of eye lashes caused by the louse Pthirus pubis treatment after consulting primary health center. Clinical properties of the patient seemed like blepharoconjunctivitis at first look in biomicroscopic ophthalmological examination, but after performing magnification in biomicroscopy, parasites and their nits were found adhering to the eyelashes of bilateral superior eye lids and eye brows [Figure 1] and [Figure 2]. The diagnosis was phthiriasis palpebrarum because of the clinical appearance of the patient. We mechanically removed all lice and their nits with an aid of a forceps after application of liquid Vaseline (Mayaset med, Turkey). The diluted %5 povidone-iodine was applied to the eyelashes of the patient. This treatment was performed in every day for about 1-week. The lice and their nits were removed after this treatment.
|Figure 1: First look of the eyelashes in biomicroscopic ophthalmological examination|
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Phthiriasis palpebrarum is an uncommon infestation of eye lashes caused by the louse P. pubis. We aimed to report a case that had louse infestation of eye lashes and brows in this article.
An uncommon infestation of eye lashes and easily overlooked cause of blepharoconjunctivitis that generally occurs as a result of colonization of P. pubis to the eye lid margins and lashes, which is primarily adapted to living in pubic hair.  Phthiriasis palpebrarum infestation may lead to a form of pruritic blepharoconjunctivitis. The diagnosis of this problem may be considerably difficult because of the colonization of the lice initially to the roots of the eye lashes.
The process of recognition without performing magnification property of biomicroscopy is reasonably difficult because of transparent structure of the lice and localization in roots of eye lashes initial. Therefore, lice infestation may easily overlooked and enter to the chronic phase.
There are various treatments in lice infestation. Mechanical removal of lice and their nits from eye lashes is the most important stage. Besides this, usage of cryotherapy, argon laser phototherapy, pomades consisting of physostigmine are also reported. ,,
| References|| |
|1.||Yi JW, Li L, Luo da W. Phthiriasis palpebrarum misdiagnosed as allergic blepharoconjunctivitis in a 6-year-old girl. Niger J Clin Pract 2014;17:537-9. |
|2.||Ebeigbe JA, Osaiyuwu AB. Pediculosis palpebrarum initially diagnosed as blepharitis. S Afr Optom 2009;68:91-9. |
|3.||Ronchese FN. Treatment of pediculosis ciliorum in an infant. Engl J Med 1953;249:897-8. |
|4.||Awan KJ. Cryotherapy in phthiriasis palpebrarum. Am J Ophthalmol 1977;83:906-7. |
|5.||Awan KJ. Argon laser phototherapy of phthiriasis palpebrarum. Ophthalmic Surg 1986;17:813-4. |
[Figure 1], [Figure 2]