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Title Cicatricial Upper Eyelid Ectropion Secondary to Self-Inflicted Skin Trauma in Delusional Parasitosis
Number 323
Author Abdi Malik Musa
Principal Unit where research was undertaken Royal London Hospital

Purpose Delusional parasitosis is a psychiatric disorder characterised by a fixed false belief of infestation despite no medical evidence. Patients often engage in repetitive skin picking or attempts to remove perceived parasites, resulting in chronic excoriation, scarring, and infection. Ocular and periocular complications are rarely reported. We present a case of a 46-year-old woman who developed severe self-inflicted periocular injury causing cicatricial ectropion of the right upper eyelid and exposure keratopathy.
Methods Retrospective case review including clinical history, ophthalmic examination, and surgical management.
Results The patient was referred from psychodermatology with infected exposure keratopathy. Examination revealed CF vision and a 2 mm central stromal infiltrate. Significant cicatricial ectropion of the right upper eyelid was present, with anterior lamellar shortening temporally and scarring extending to the temple due to chronic excoriation. Initial management targets treating the corneal ulcer. Definitive surgery involved cicatricial release and full-thickness skin graft (fro left retroauricular area) reconstruction, improving eyelid position and resolving corneal exposure. The patient missed several post-operative appointments but, following safeguarding escalation, re-engaged with services and attended further assessment. Eyelid position was improved with resolution of retraction.
Conclusion Delusional parasitosis can cause severe anterior lamellar deficiency and cicatricial upper eyelid ectropion with sight-threatening exposure keratopathy. Oculoplastic surgeons should recognise self-inflicted periocular injury as a cause of complex eyelid malposition. Optimal outcomes require surgical reconstruction alongside safeguarding and coordinated psychiatric management to reduce recurrence and protect ocular health.

Additional Authors

First name Last name Hospital / Institution
Michael Spinosi
Nikhil Cascone



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