“LURKING LICE”: A rare case of phthiriasis palpebrarum in a scleral contact lens wearer

Scleral contact lenses (CLs) are widely used to correct compromised vision due to irregular corneas. Owing to their minimal contact with the cornea, complications associated with these lenses are less frequent, in which patients might present with symptoms like redness, lid swelling, and visual complaints. These symptoms are very frequently attributed to CL intolerance, sometimes even overlooking the possibility of another cause. This report presents one such case where a 49-year-old female was fitted with mini-scleral rigid gas permeable (RGP) lenses after she developed corneal ectasia post-radial keratectomy (RK). She presented with conjunctival congestion and lid edema after 6 months of normal CL use. On initial examination, the case seemed leaning toward CL intolerance, but detailed examination led to the diagnosis of phthiriasis plapebrarum.