The similarities of the larval and nymph stages of the tick and louse (Pthirus 
pubis) may lead to misdiagnosis in rare cases of infestation of the eyelashes. 
The most frequent manifestations of tick in the eye are conjunctivitis, uveitis, 
keratitis, and vasculitis. Tick inoculation of the skin can locally lead to 
formation of granuloma and abscess. More concerning is the potential systemic 
sequelae that can result from transmission of zoonoses such as Lyme disease. P. 
pubis can cause pruritic eyelid margins or unusual blepharoconjunctivitis. We 
present a case of phthiriasis palpebrarum in a 4-year-old boy.