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)