Pediculosis Ciliaris: Pthirus Pubis

A 5-year-old female presented to the ophthalmology department with complains of ocular pruritus for the past month. Slit-lamp biomicroscopy revealed translucent egg-shaped nits (black arrow) and adult lices (white arrowhead) attached to the eyelashes. Microbiological examination identified Pthirus pubis. Pediculosis capitis is common in children, but lashes´ involvement is rare and if present it must raise concern for pthirus pubis. These infestations may spread through close contact with an infected individual and sexual abuse must be excluded as this can be a sexually transmitted disease. Parasites were removed using forceps. Botulinium toxin A (2.5U/0.1ml) applied on the eyelashes may be helpful. She was successfully treated with tobramycin 0.3% and ivermectin 200 μg/kg. Advise was given on clothing to be washed at 50º C for at least 30 minutes. She was referred to the dermatology and paediatric departments to treat associated infestations and rule out other sexually transmitted diseases.