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Year : 1980  |  Volume : 28  |  Issue : 1  |  Page : 39-41

Phthiriasis palpebrarum

Department of Ophthalmology Rangaraya Medical College, Kakinada, India

Correspondence Address:
S C Reddy
Department of Ophthalmology Rangaraya Medical College, Kakinada
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Source of Support: None, Conflict of Interest: None

PMID: 7203596

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How to cite this article:
Reddy S C. Phthiriasis palpebrarum. Indian J Ophthalmol 1980;28:39-41

How to cite this URL:
Reddy S C. Phthiriasis palpebrarum. Indian J Ophthalmol [serial online] 1980 [cited 2020 Oct 21];28:39-41. Available from: https://www.ijo.in/text.asp?1980/28/1/39/31047

Infestation of the eye lashes by Phthirus pubis crab louse, belonging to the order of ano­plura of family pediailidae and genus phthirus, is more common than the head louse but is never the less rare. The hominoxious, haema­tophagic parasite resembles the head and body louse except its second and third pairs of legs and claws are stouter. The abdoman is more or less telescopic so that the first three abdo­minal spiracles (segments 3, 4 and 5) are almost in one transverse line. The abdoman is broader than its length, resembling a crab[3]. The adult female is greyish white, 3-4 mm long, the male is slightly smaller. The legs are adopted for grasping hairs. During the life span of about a month, the female lays 7-10 eggs erch day. The eggs (nits) hatch in about 8 days and the nymphs require a further 8 days to reach maturity[12]. The eggs are laid and cemented on the hairs, have a darkish colour, their cap or operculum is conical and covered wite prominent round, perforated nodules on the central surface[3].

Although pubic hair is their main habitat, these lice are quite often found on the hairs of abdomen, thighs and in the exilla. Rarely they may invade the eyebrows and eye lashes[11]. Its occurance in different parts of the world has been reported, from time to time, by different authors[2],[3],[5],[6],[8],[9],[11],[14],[15]. But, very few authors[10],[13] have reported its occurrence from our country. Hence these two cases are reported.

  Case reports Top

Case No. 1 :- A 18 years old male college student came to eye department on 3rd March, 1979 with the complaint of itching of the eye lids of both eyes since three weeks. On exami­nation there were many greyish, white, oval, particles on the margins of both upper lids. Visual acuity, anterior segment and fundus were normal in both eyes.

Examination with the binocular loupe reveled blepharitis of both upper lids and many gray coloured lice on the lid margins near the roots of the cilia along with numerous greyish white nits on the cilia. Few lice were found on the lower lid margins also. Some of them were firmly gripping the skin of the eye lids with their claws. No lice were found on the eye brows or scalp. But the axillary and pubic hair were infested with lice. Few para­sites and nits were removed from eye lashes, axiallary hair and pubic hair with forceps and examined under the microscope. All of them were diagnosed to be phthirus pubis [Figure - 1],[Figure - 2]

All the lice and nits were removed with epilation forceps as far as possible, but when the louse was firmly grasping at the root of the cilia were epilated. The patient was advised to rub the yellow oxide of mercury ointment 1%, three times daily over the lid margins. shaving of axillary and pubic hair followed by application of the same ointment in those regions. The patient was clear of all the lice and nits after one week. The same treatment was continued at bed time for three weeks with a weekly follow up. There was complete cure of the disease without any recurrence.

Case No. 2 :- A 1 years old school boy came to eye department on 6th May, 1979 with complaints of itching of the eye lids and burning sensation in both eyes since one month. On Examination multiple grey coloured lice were seen over the upper lid margins of both eyes near the roots of cilia, with plenty of greyish white nits on the cilia [Figure 3]. The lid margins were inflammed Few lice and nits were also present on the lower lid margins. The findings were similar in both eyes. Visual acuity, anterior segment and fundus were normal in both eyes. Some of the lice were firmly gripping the skin of lid margins with their claws. There were no lice on the eye brows or scalp. Auxiliary hair were scanty anti not well developed, but the pubic hair were infested with lice, Few parasites and nits were removed from the eye lashes and pubic hair with the forceps and examined under the microscope which showed all the features of phthirus pubis.

As the infestation was severe, the cilia of both eyes were trimmed and the remaining lice were removed with forceps. Patient was advised to apply yellow oxide of mercury ointment 1% three times daily over the lid margins, and shaving of pubic hair followed by application of the same ointment in that region, Blepharitis was cured within a week ane the patient was clear of all lice and nits in a period of ten days, The same treatment was continued at bed time for another three weeks. The patient was followed up with a weekly check up and there was complete cure of the disease without any recurrence.

  Discussion Top

The occurance of blepharitis due to phthirus pubis is rare (2 cases out of 22698 Opthalmic patients, from July, 1978 to October, 1979). The infestation is seen usually in children, particularly the inhabitants of crowded slums or living in poor hygeinic conditions. Ocassio­nally parasites cause blepharitis - blepharitis acarlca, due to demodex folloculorum and phthirasis palpebrarum, due to crab louse, very rarely to the head louse[7].

Blepharitis due to pediculosis pubis has been reported in children of 1½ years ages[6],[11]. Being almost the colour of the skin, they are not easily identified and for this reason the infestation may exist for a long time before its recognition. But the presence of nits on the eye lashes, which are readily visible, gives clue to the diagnosis of this condition.

The most common symptom is itching and it is due to a dermal hypersensitivity. Blepha­roconjunctivitis[1] and lid abscess[10] may occur if infection ensues. Blepharitis is not by any means invariable, for lice may be found on normal palpebral margins, but frequently itching, scratching, and rubbing lead to true inflammation which may be very presistant and intense[4].

The parasite probably reaches the eye by transmission by the hand from the pubic hair[5], only occassionally are the lashes infested without pubic involvement[4]. Head to head is usual mode of transmission of lice in children[3]. Infestation is usually ransmitted by sexual contact, but may be transferred on clothing or towels, sometimes from shed hairs. The site of parasitasation often indicates the mode of transmission, for these lice move only very short distance from the point of their first contact. Eye lash infestation in infants has been derived from the bieast of the mother[11]. Inspite of the fact that the pubic louse may be found on the eye brows and eye lashes of patients with extreme infestation, involvement of scalp is extremely rarer[6].

The mode of transmission in the present cases under report seems to be by hand, from pubic or axillary hair to the eye, as there was associated infestation of pubic and axillary hair by the same parasite in the first case, and infestation of pubic hair in the second case. Ophthalmological and dermatological exami­nation of the family members did not reveal any clue to the root of infestation in both the cases.

The treatment of pediculosis of the eye lids is removal of lice and nits with the forceps and application of yellow oxide of mercury oint­ment 1% over the lid margins[9]. Equally good results may be obtained with drops or ointment of physostigmine 1 % or tetra-ethylpyro­phosphate, pyrethrum ointment or gamma benzene hexachloride 1 % cream. Epilation or shaving is necessary only in cases of severe infestation, but the efficient delousing of the initial nidus in the genitalia by D.D.T. (dichloro-diphenyl-trichlore ethane), benzyl benzoate or one of its preparations must be through[4].

  Summary Top

Two cases of belpharitis due to phthirus pubis in young male patients are reported. The literature is reviewed. The life cycle of crab louse, its mode of infestation and treat­ment of the disease are discussed.

  References Top

Belan, P.G. and Rucker, C.W., 1961, Proc. Mayo Clinic, 36:234  Back to cited text no. 1
Bease, A.J., 1945, East. African Med. J. 22:271.  Back to cited text no. 2
Bose, J , 1955, Amer. J. Ophthalmol., 39: 211.  Back to cited text no. 3
Duke Elder, S., 1974, System of Ophthalmology, Ocular Annexa, Vol. XIII, Part-I, diseases of eye lids, p. 195-199, Henry Kimpton, London.  Back to cited text no. 4
Friedman, R. and Wright C.S,, 1934, Arch. Ophthalmol., 11: 995.  Back to cited text no. 5
Goldman, L. and Friedman L.S., 1941, Amer. J. dis. Child, 61: 344.  Back to cited text no. 6
Miller, S.J.H., 1978, Parson's diseases of the Eye, 16th ed. p. 509, The English Language Book Society. Churchill Livingstone­  Back to cited text no. 7
Moses, L., 1965, Amer. J. Ophthalmol, 60:530.  Back to cited text no. 8
Perlman, H.H. Fraga, S. and Medina, M., 1956, J. Pediat, 49: 88.  Back to cited text no. 9
Redger, F.C. and Farooqui, H.V., 1959, Brit. J. Ophthalmol. 43: 676.  Back to cited text no. 10
Ronchese, F., 1953, New Engl. J. Med; 249: 897.  Back to cited text no. 11
Rook, A.. Wilkinson, D.S. and Ebling, F.J.G. 1972, Text book of Dermiatology, Vol-I, 2nd Ed. p858 861, Black Well Scientific publications, London.  Back to cited text no. 12
Sarma, C.M., 1970, J. All India ophthalmol, Soc., 18: 190.  Back to cited text no. 13
Uneo, A., Itotagawa, S. and Oyamada, Y., 1975, Jap J. clin. Ophthalmol, 29: 1325,  Back to cited text no. 14
Wolter, R. and Burnes,. 1970, J. pediat. ophthal­mol., 7:5.  Back to cited text no. 15


  [Figure - 1], [Figure - 2]


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