BACKGROUND: Pediculosis capitis is a common parasitic infestation, whereas 
phthiriasis palpebrarum is an uncommon infection due to Phthirus pubis (pubic 
lice) inoculating the eyelashes and surrounding tissues of the eye. Emergency 
physicians should recognize the causes of this uncommon disease. Cases of 
phthiriasis palpebrarum should trigger the clinician to consider the potential 
for child abuse when suspected or when social history dictates the risk for 
abuse.
OBJECTIVE: A case of a pediculosis capitis and phthiriasis palpebrarum 
coinfection in a 4-year-old girl is presented, which was suspicious for child 
abuse given the patient's social history. Diagnosis, treatment, and need for 
vigilance when encountering cases of phthiriasis palpebrarum, especially in 
young children, are discussed herein.
CASE REPORT: A 4-year-old girl presented with swelling and redness around her 
eyes. The girl had recurrent head lice infestations, however, on the day of 
presentation the mother noted lice appeared on the girl's eyelashes and eyelids. 
Head lice typically do not infect the eyes, and given the different morphology 
of the lice on the patient's head and eyes, a diagnosis of phthiriasis 
palpebrarum was made. Because phthiriasis pubis infection of the eyelids may 
represent sexual abuse, especially in children, child protective services was 
notified to ensure patient safety.
CONCLUSIONS: Pediatric phthiriasis palpebrarum can represent child abuse, and 
the origins of this infection need to be carefully discerned. A thorough history 
can provide information to assess whether further action is needed and, if in 
doubt, social services should be contacted to ensure child safety.