Chronic conjunctivitis related to phthiriasis palpebrarum
Department of Ophthalmology, Hospital Federal dos Servidores do Estado do Rio de Janeiro, Rua Sacadura Cabral, 178, Rio de Janeiro, RJ, 20221-903, Brazil, .International Ophthalmology (Impact Factor: 0.55). 06/2012; 32(5):467-9. DOI: 10.1007/s10792-012-9528-2
We describe a case of chronic conjunctivitis related to phthiriasis palpebrarum. A 36 year-old female presented with gradual pruritus and painless ocular hyperaemia over the previous 3 months. On examination, nasal pterygium, conjunctival hyperaemia, oedema, and mild hypertrophy of the palpebral margin were observed. A slit-lamp examination revealed numerous creamy oval structures approximately 1 mm in diameter localised in the middle area of the lashes, and bloody crusts and a semi-transparent deposit were present in the superior palpebral margin. Based on the observation of numerous nits at the base of the eyelashes and the ectoparasite in the palpebral margin, a diagnosis of phthiriasis palpebrarum was made. The patient was referred to an infectologist for evaluation of other sexually transmitted diseases and examination of other body areas. She was successfully treated with oral ivermectin, shampoo for ciliary hygiene and artificial tears. Other recommendations to avoid re-infestation were made, such as changing, washing and sterilising clothes, towels and sheets daily. This report emphasizes the importance of the correct diagnosis and management of this disease, considered as sexually transmitted.
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ABSTRACT: Purpose: Hemolacria is a rare phenomenon of bloody tears caused by various ocular and systemic conditions, as well as psychological, pharmacologic, and idiopathic etiologies. Hemolacria is typically a benign process; however, serious systemic associations can exist. It is predominantly unilateral and self-limiting, but because of limited literature, its prevalence and predilection toward a specific gender, race, or age is not known. Case report: An 82-year-old Caucasian male presented for an emergent eye examination with an acute onset of hemolacria of the right eye (OD). Patient medical history was extensive with coronary artery disease, atrial fibrillation, lipidemia, insulin-dependent diabetes, uncontrolled hypertension, and untreated severe renal failure. Before the incident, patient medication included warfarin, 81 mg of aspirin, insulin, glipizide, and blood pressure regime with which the patient was noncompliant. The patient was forwarded to urgent care to address his stage 2 hypertension and referred for a medical evaluation, which included a complete blood count, an International Normalized Ratio, a prothrombin time, and a glycated hemoglobin. Conclusions: Spontaneous resolution of the hemolacria occurred within 24 hr after evaluation and restoration of blood pressure to normal range. Before follow-up, the patient died because of kidney failure. After a review of pertinent laboratory results and literature, the etiology of this patient's hemolacria could be attributed to either uncontrolled hypertension, chronic renal failure, aggressive anticoagulant therapy, and/or diabetes. An extensive literature review of documented etiologies and management is included.
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ABSTRACT: Phthiriasis palpebrarum is an ectoparasitosis in which Phthirus pubis infest the eyelashes. It is rare and it can easily be misdiagnosed as blepharitis. The purpose of this study is to describe seven cases of phthiriasis palpebrarum so as to discuss its mode of infestation, diagnosis and treatment. This is a study of all cases of phthiriasis palpebrarum reported in our laboratory. For each patient, an ophthalmic examination and parasitological examination of the eyelashes were performed. There were five men and two women. Their ages ranged from 4 to 50years with an average of 21.57years. There were four children and three adults. The main symptom was itching of the eyelids. Clinical signs included reddish-brown crusts at the base of the eyelashes in all the cases and visible lice and nits in three cases. Biomicroscopic examination showed lice and nits anchored to the eyelashes in three cases. In the other two cases, the initial diagnosis was felt to be blepharitis. In all cases, the diagnosis of phthiriasis palpebrarum was confirmed by parasitological examination of eyelashes, which revealed the presence of adult and nit forms of Phthirus pubis. The number of adult lice ranged from 1 to 30. In all cases, treatment was based on mechanical removal of both the lice and nits. Outcomes were favorable without recurrence. In conclusion, phthiriasis palpebrarum can be easily diagnosed by close examination of the eyelashes and eyelid margins at the slit lamp and can be managed mechanically. Parasitological examination of the eyelashes can confirm the diagnosis.
Article: Common Cutaneous Parasites[Show abstract] [Hide abstract]
ABSTRACT: This issue provides a clinical overview of Common Cutaneous Parasites focusing on prevention, diagnosis, treatment, practice improvement, and patient information. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from ACP Smart Medicine and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult http://smartmedicine.acponline.org, http://mksap.acponline.org, and other resources referenced in each issue of In the Clinic.
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