Here's What Lice Infesting Your Eyelashes Looks Like

Microscope images of the patient’s lice.
Image: Xue Feng and Hong Qi/© The New England Journal of Medicine (2021)

Here’s an eyebrow-raising sight. This month, doctors in China reported on a rare case of phthiriasis palpebrarum, or an infestation of pubic lice on the eyelashes, complete with clear images of the itchy offenders. Though it’s not clear how the lice ended up on the young patient, doctors were able to treat her infestation with no issues.

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The case report was published July 3 in the New England Journal of Medicine by doctors Xue Feng and Hong Qi from the Peking University Third Hospital in Beijing, China. According to the report, a 8-year-old girl visited the hospital after experiencing three weeks of itchy eyelids. Upon examination, the eyelids were reddened. And when the doctors looked closer, they spotted the clear presence of adult lice and nits on the girl’s eyelashes. The lice were then confirmed to be Phthirus pubis, also known as pubic lice or crabs.

Images of the patient’s lice captured via slit-lamp examination (A) and via a microscope (B and C)
Image: Xue Feng and Hong Qi/© The New England Journal of Medicine (2021)

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Pubic lice, as the name suggests, are parasitic insects that live primarily in the pubic hairs around our genitals and feed off our blood. They’re a distinct species from the lice that can live on our scalp or body hair (body and head lice are very closely related to each other but are different in important ways). But on rare occasions, pubic lice can migrate to and survive on the more coarse hairs of the body that resemble the pubic region, including the eyelashes.

Obviously, finding pubic lice on a young girl would raise concerns about her safety. But the doctors said they didn’t find lice on any other part of the girl’s body, nor on her parents. Ultimately, they reported not finding any evidence that the girl had been sexually abused. While these lice do commonly spread through sexual contact, the doctors note that they can also be transmitted through simply touching shared surfaces or objects that carry them, particularly things like towels, bedding, and clothing.

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The girl’s lice and nits were physically removed and the clothes and bedding of her family members were washed in hot water and kept separate from hers, while sharing in general was limited for a short time. Two weeks later, she returned for a follow-up with no itchy eyelids and no signs of further infestation.

Human lice of all kinds remain a common nuisance, and, contrary to popular belief, regularly plague all corners of society, rich and poor alike. But even in wealthier countries, those with fewer resources are less able to promptly seek treatment for infestations, allowing the lice to spread to others. It’s estimated that somewhere between 6 million and 12 million infestations of head lice happen every year in the U.S. among kids ages 3 to 11.

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