This guideline last updated 06/05/2022 17:42:43

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)