Sir, Phthiriasis palpebrarum is the most common eyelid infestation caused by _Phthirus pubis_ (pubic lice), sometimes referred to as crab lice CASE REPORT Two brothers, aged 8 and 3 years,

presented to the casualty with a 3-week history of itchy red eyes. They had no previous ocular history and were generally fit and healthy. They lived with their parents and one other

brother, who had no ocular complaints. The visual acuity of the older boy was 6/6 and that of the younger boy was not recordable. On examination, lice and nits were noted on the eyelashes of

both patients, and microscopic examination subsequently confirmed these as pubic lice (Figure 1). The children were managed with Oc. Pilogel 4% applied twice daily to the lashes, leading to

(eyelashes, beard, chest, axillary region, pubic region).1 They rarely infest the scalp. _Pediculosis palpebrarum_ is an eyelid infestation caused by _Pediculus humanus corporis_ (body lice)

or _Pediculus humanus capitus_ (head lice). _Pediculus_ species are 2–4 mm long and typically infest the hair. Infestation of the cilia, however, is rare. Ocular signs and symptoms include

the following: bilateral ocular itching, irritation, visible lice and nits, visible erythematous lesions resulting from louse bites, reddish-brown deposits on the lashes (louse faeces)

secondary blepharitis, follicular conjunctivitis, and marginal keratitis. Adult females lay eggs on the hair shafts, which are resistant to mechanical and chemical removal. They lay as many

as 26 eggs (up to 3 eggs a day),1 which hatch every 7–10 days. The average lifespan of adult lice is less than a month, and they die within 24–48 h if removed from their hosts. They

interbreed freely within different species. Crowded conditions and poor personal hygiene may be reasons for infestation. A number of treatment options are available. These include trimming

or plucking of eye lashes,2,3 traumatic amputation, cryotherapy,4 argon laser photocoagulation,5 fluorescein 20%,5 physostigmine 0.25%,6 Q1lindane 1%,7 petroleum jelly,8 yellow mercuric

oxide ointment 1%,8 malathion drops 1% or malathion shampoo 1%,9 and pilogel 4%. The exact mechanism of action of pilocarpine 4% gel is not yet known. It could be attributed to its direct

cholinergic action of depolarising the effector cell, causing paralysis of the lice, or because of direct pediculocidal action or even the smothering effect of the gel. Pilocarpine 4% gel is

cheap and easily available and has much less side effects than indirectly acting cholinergic agonists like physostigmine or organophosphorous compounds, as they have a longer duration of

action than pilocarpine. These patients require follow-up for 7–10 days, and education regarding transmission to avoid interpersonal contact until completely cured. Laundering of potential

fomites (eg towels, pillow covers, sheets, hats) at a temperature exceeding 131°F for more than 5 min kills the eggs, nymphs, and mature lice. Since adult lice cannot survive more than 48hrs

if separated from the host, and nits hatch in 7–10 days, careful sealing of fomites in plastic bags for 2 weeks can also be effective. Lastly, pubic lice in children may be an indication of

sexual abuse, and it is of interest that the patients discussed herein were reported to have shared a bed with an uncle on several occasions. There has been a resurgence of pubic louse

infestation from increased sexual activity in the adolescent population, and associated venereal diseases have been detected in a large percentage of involved subjects.7 REFERENCES * Nuttall

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AFFILIATIONS * Kent County Ophthalmic and Aural Hospital, Church Street, ME14 1DT, Kent, UK N Kumar, B Dong & C Jenkins Authors * N Kumar View author publications You can also search for

this author inPubMed Google Scholar * B Dong View author publications You can also search for this author inPubMed Google Scholar * C Jenkins View author publications You can also search

for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to N Kumar. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Kumar, N., Dong,

B. & Jenkins, C. Pubic lice effectively treated with Pilogel. _Eye_ 17, 538–539 (2003). https://doi.org/10.1038/sj.eye.6700422 Download citation * Published: 15 May 2003 * Issue Date: 01

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