Rare Manifestations of Phthirus Pubis on the Eyelids of a Child withChronic Blepharitis

years old boy. Case Illustration A 5-year-old boy came with his parents complaining of itching of the eyelids for 2 months ago. The caregiver of the patient had complaints of itching in the genitals for 6 months ago. This symptom was unresponsive to topical antibiotics started 1 month before the consultation. Examination of the eyelids revealed a lot of crabs-like lice and nits that attached to the upper eyelashes of both eyes. A papillary reaction in the tarsal conjunctival of both eyes was noted. The treatment was the mechanical removal of lice and nits by using epilation forceps. The caregiver has treated with permethrin 1% lotion once a week. There were no lice and nits in 2 weeks after. Discussion Misdiagnosis of phthiriasis palpebrarum leads to inappropriate management and increases the chance of complication to conjunctiva and cornea tissue. The treatment is mechanical lice and egg removal and medication. Pharmacologic treatment was antibiotic ointment, petrolatum jelly, or 4% pilocarpine jelly as a medium for occlusion. Giving oral ivermectin can paralyze the peripheral neurovascular system of lice. The administration of systemic therapy is indicated for the involvement of a large area of the infestation. Mechanical removal of lice and nit alone was effective in this case. Conclusion Eyelashes examination under a slit lamp or magnifying lens is important to avoid misdiagnosis of chronic blepharitis. Mechanical removal is sufficient in the management of phthiriasis palpebrarum. Keyword Phthirus Pubis, Blepharitis, Lice