# Tinea Blepharociliaris: A Case Report

## TL;DR

This case report describes a rare fungal eyelid infection misdiagnosed as bacterial, highlighting the importance of identifying atypical symptoms and contact history for early diagnosis.

## Contribution

The paper presents a unique case of tinea blepharociliaris with an atypical lesion and emphasizes diagnostic strategies to avoid misdiagnosis.

## Key findings

- A 25-year-old female presented with a fungal eyelid infection misdiagnosed as bacterial due to atypical symptoms.
- Microscopic examination confirmed the presence of fungal spores, leading to successful treatment with oral terbinafine.
- The case underscores the need to consider fungal causes in persistent or atypical blepharitis cases.

## Abstract

Blepharitis is a prevalent inflammatory disease of the ocular surface, traditionally associated with bacterial infections or helminth mite parasites. However, recent studies have demonstrated that dermatophyte infections of the eyelids can trigger fungal blepharitis, and this condition can be misdiagnosed as eczema or bacterial infections due to its atypical clinical manifestations. In this article, we present a case of fungal blepharitis in a 25-year-old female patient, an isolated brown crust around the eye (atypical lesion), and a six-month history of possible exposure to contaminated cosmetics were the key features distinguishing the case from a bacterial infection. The patient had been administered glucocorticoids inappropriately, resulting in the migration of the lesion. The diagnosis was confirmed through microscopic examination, which revealed the presence of rod-shaped, large, and small spores. The condition was resolved through the administration of oral terbinafine for two weeks. This case emphasizes that tracing the source of contact and identifying subtle signs (e.g., sesame scab) in the medical history are key to the early diagnosis of fungal eyelid infection and to avoid the chronicity caused by misdiagnosis. When determining the cause of blepharitis, particular attention should be paid to a history of recalcitrance to conventional therapy and the presence of atypical lesions, such as brownish crusts.