Muhammad Dawood Khan, Hannan Masud, Khalid Mahmood.
Pediculosis palpebrum.
Pak J Pathol Jan ;12(4):40-2.

A young female, 24 years of age, presented with matting of the eyelashes and itching in left eye of one year duration. She received treatment for blepharitis and allergic conjunctivitis with antibiotic and steroid eye drops / ointments from various specialists but with no improvement. On examination, her visual acuity was 6/6 unaided in both eyes. Slit lamp examination of left eye showed dry scaly discharge with cutaneous horn like formation at upper lid margin due to matting of eyelashes. When the apparent cutaneous horn was pulled with forceps, it broke at the site of pinching proving that it was not a cutaneous horn but just hardened dry exudate. Reddish-brown deposits (louse faeces) were seen on a few eyelashes of the upper eyelid. Rest of the ocular examination was unremarkable. Examination of her right eye was also unremarkable. The patient was examined by dermatologist. Head lice were found in the scalp, especially in the post-auricular and occipital areas. A few scalp hairs were epilated and examined under light microscope. Diagnosis was confirmed on the observation of eggs (nits), nymphs and mature lice attached to hair shafts. The patient was treated with topical application of white petroleum jelly and eyelid massage for seven days. The patient was instructed to use fine-tooth comb for removal of scalp nits and to apply 1% lindane lotion at the scalp to treat the reservoir.

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