Delusional Parasitosis as a Cause of Cicatricial Upper Eyelid Ectropion
Author: Abdi Malik Musa Base Hospital / Institution: Royal London HospitalePoster presentation
Abstract ID: 26-453Purpose
Psychiatric disorders with dermatological manifestations present an emerging challenge in oculoplastic practice. Delusional parasitosis drives repetitive self-excoriation that can extend to the periocular region with sight-threatening consequences. Adnexal involvement remains largely unreported in the oculoplastic literature.
Methods
Retrospective case review of a 46-year-old woman with a history of methamphetamine use, significant psychiatric comorbidities, and homelessness, referred from psychodermatology with periocular self-inflicted injury.
Results
Presentation revealed counting fingers vision in the right eye with a 2 mm central stromal infiltrate and lagophthalmos secondary to cicatricial upper eyelid ectropion. Oculoplastic examination demonstrated anterior lamellar shortening temporally, with dense scarring extending to the temple from chronic self-excoriation. Initial management prioritised resolution of the corneal ulcer with intensive lubrication and topical antimicrobials. Definitive surgery involved cicatricial release and full-thickness skin graft reconstruction, restoring eyelid position and resolving exposure keratopathy. Post-operatively, safeguarding escalation was required after missed follow-up appointments, following which the patient re-engaged with multidisciplinary services.
Conclusion
Delusional parasitosis, including cases precipitated by methamphetamine use, can cause severe anterior lamellar deficiency and cicatricial upper eyelid ectropion with sight-threatening exposure keratopathy. Psychiatric illness and substance misuse must be recognised as primary and underrecognised drivers of complex periocular self-injury. Surgeons must maintain a high index of suspicion when scarring is inconsistent with recognised pathology. Operative success depends not only on technical reconstruction but on early psychiatric engagement, substance misuse support, safeguarding awareness, and sustained multidisciplinary follow-up to prevent recurrence and preserve long-term ocular health.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Michael | Spinosi | Royal London Hospital |
| Nikhil | Cascone | Royal London Hospital |
