Date of last review: Due to be updated
Differential diagnosis
- Blepharitis (anterior)
- Nits may be confused with lash debris
- Demodex mites are much smaller than crab lice (0.1–0.4mm long) and are not usually seen outside the lash follicle
- Allergic reactions affecting lid skin
Possible management by Optometrist
Treatment
- Remove lice, nits and shells (casts) at slit lamp
- Use forceps (lice have a tenacious grip on the lashes)
- Application of Simple Eye ointment to the lid margins will suffocate lice (unmedicated ointment, applied twice daily for at least 2 weeks)
- Permethrin 1% lotion applied to lashes for 10 minutes with eyes closed
- NB: insecticides can be toxic to the cornea
- Advise on any symptoms of pubic infestation
- Effective treatments (e.g. malathion, permathrin) available without prescription from pharmacies
Advice
- Sensitive counselling required as this is a sexually transmitted disease
- Give advice on personal hygiene: wash hands after touching pubic region
- Be sensitive to possibility of sexual abuse of children
- Sexual partners or family members at risk should have their eyes examined and treated if necessary
- Bed linen, towels and clothes should be washed at 60°C for at least 5 minutes
Management Category
- Alleviation / palliation
- Normally no referral to ophthalmologist, unless heavy infestation present or does not respond to treatment
Possible management by Ophthalmologist
- Heavy infestation can be reduced by Argon laser photo-ablation or cryotherapy (freezing)