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Lu Y, Gong L, Yin Y. Need to Increase the Number of Intense Pulsed Light (IPL) Treatment Sessions for Patients with Moderate to Severe Meibomian Gland Dysfunction (MGD) Patients. Curr Eye Res 2024; 49:362-367. [PMID: 38174380 DOI: 10.1080/02713683.2023.2297344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE To evaluate whether patients with moderate-to-severe meibomian gland dysfunction (MGD) will benefit from increasing the number of intense pulsed light (IPL) treatment sessions. METHODS Ninety Asian adult with MGD (stages 3-4) were enrolled in this retrospective study. In Group1, 30 patients completed the five-session IPL treatment, 63.33% of which also received meibomian gland expression (MGX). In Group 2, 60 patients received three-session IPL treatment, 60.0% of which also accepted MGX. Both intragroup and intergroup analyses were conducted. RESULTS The population characteristics, clinical baseline characteristics and therapeutic regimen were comparable between Group1 and Group2. The symptoms and most clinical indices improved after IPL treatment finished in both two groups. No statistical difference was found in any improvement level of all symptomatic and physical indices, including the Ocular surface disease index, tear break-up time, Demodex, corneal staining, meibum quality, meibomian gland expressibility, and MGD stage (all p ≥ 0.05) between the two groups at any time, not only month by month, but also at the terminal visit. However, the response rate of Group1 after the five-session treatment (70.00%) was increased compared to that of Group2 after the three-session treatment (63.33%). CONCLUSIONS Increasing the number of IPL sessions is beneficial for patients with moderate to severe MGD to increase the response rate of treatment, rather than the improvement level. However, there is no need for patients who respond well to a routine number of IPL treatments to undergo additional IPL sessions.
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Affiliation(s)
- Yang Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Lan Gong
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Yue Yin
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
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2
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Bitton E, Wittich W. Double-Blind Comparison of Eyelash Epilation Techniques for the Purpose of Demodex folliculorum Mite Retrieval. Eye Contact Lens 2024; 50:152-157. [PMID: 38345025 DOI: 10.1097/icl.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Demodex folliculorum blepharitis is typically confirmed with lash epilation and microscopic identification of mites. However, mite counts may vary with the epilation technique. As there is no gold standard to epilating lashes for the purposes of mite counts, the aim of this study was to compare three epilation techniques. METHOD A prospective randomized double-blind study compared three epilation techniques on lashes with cylindrical dandruff. Techniques included (A) direct pulling of the lash; (B) rotating the lash before epilation; and (C) sliding the cylindrical dandruff away, lash rotation, and epilation. Mean mite counts were analyzed using a repeated-measures analysis of variance. RESULTS Forty (n=40) participants (20 M: 20 F, mean age of 62.3±17.1 years) revealed similar mite counts between right (1.43±1.74) and left (1.35±1.59) eyes ( P =0.63). A significant difference ( P =0.03) in mite count was noted (technique A: 1.05 ± 1.60; technique B 1.76 ± 1.80; and technique C 1.36 ± 1.54) with technique B yielding the highest mite count ( P =0.04). CONCLUSION Demodex mite count is a key parameter in establishing infestation or to determine treatment efficacy. This study revealed that rotating the lash before epilation yielded the highest mite count. Future studies should report the epilation technique used to allow for study comparisons.
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Affiliation(s)
- Etty Bitton
- École D'optométrie, Université de Montréal, Montreal, QC, Canada
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3
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An N, Dou X, Yin N, Lu H, Zheng J, Liu X, Yang H, Zhu X, Xiao X. The Use of Digital PCR for the Diagnosis of Demodex Blepharitis. Curr Eye Res 2024; 49:33-38. [PMID: 37823373 DOI: 10.1080/02713683.2023.2265083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE This was a pilot study to evaluate the efficacy of digital polymerase chain reaction detection of Demodex in eyelid margin swabs for the diagnosis of Demodex blepharitis. This study aims to explore the possibility of digital polymerase chain reaction detection to improve the diagnostic accuracy of Demodex blepharitis detection. METHODS Volunteers were prospectively recruited and classified by experienced doctors into suspected Demodex blepharitis or healthy controls using slit-lamp evaluation of the eyelid margin and an inquiry about symptoms. Three eyelashes from each eyelid were epilated from participants in each group for microscopic observation and mite counting. Then, swabs from the eyelid margins of each eye were collected after the eyelashes were epilated and stored at -80 °C for future DNA extraction and digital polymerase chain reaction detection. The positive or negative results of both methods were compared for diagnostic accuracy, and the Kappa value was also calculated to evaluate their consistency. RESULTS The accuracy of the digital polymerase chain reaction detection was 71.6% and that of the mite counting method was 75%. Their combined accuracy was improved to 77.3%. The Kappa value of the two methods was 0.505, indicating moderate consistency. CONCLUSION Digital polymerase chain reaction detection of Demodex from ocular surface swabs was painless and noninvasive and is a potentially accurate quantitative method available for diagnosing Demodex blepharitis. This method is also complementary to the conventional mite counting method, particularly when a sufficient number of eyelashes cannot be effectively epilated.
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Affiliation(s)
- Na An
- Shaanxi Provincial Clinical Research Center for Ophthalmic Diseases, Xi'an City First Hospital, Xi'an, China
- Shaanxi Key Laboratory of Ophthalmology, Shaanxi Institute of Ophthalmology, Xi'an, China
| | - Xiuhong Dou
- Shaanxi Key Laboratory of Ophthalmology, Shaanxi Institute of Ophthalmology, Xi'an, China
| | - Ni Yin
- Shaanxi Provincial Clinical Research Center for Ophthalmic Diseases, Xi'an City First Hospital, Xi'an, China
- Shaanxi Key Laboratory of Ophthalmology, Shaanxi Institute of Ophthalmology, Xi'an, China
| | - Haiqing Lu
- Shaanxi Provincial Clinical Research Center for Ophthalmic Diseases, Xi'an City First Hospital, Xi'an, China
- Shaanxi Key Laboratory of Ophthalmology, Shaanxi Institute of Ophthalmology, Xi'an, China
| | - Jie Zheng
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xianning Liu
- Shaanxi Provincial Clinical Research Center for Ophthalmic Diseases, Xi'an City First Hospital, Xi'an, China
- Shaanxi Key Laboratory of Ophthalmology, Shaanxi Institute of Ophthalmology, Xi'an, China
| | - Hua Yang
- Shaanxi Provincial Clinical Research Center for Ophthalmic Diseases, Xi'an City First Hospital, Xi'an, China
- Shaanxi Key Laboratory of Ophthalmology, Shaanxi Institute of Ophthalmology, Xi'an, China
| | - Xiuping Zhu
- Shaanxi Provincial Clinical Research Center for Ophthalmic Diseases, Xi'an City First Hospital, Xi'an, China
- Shaanxi Key Laboratory of Ophthalmology, Shaanxi Institute of Ophthalmology, Xi'an, China
| | - Xianghua Xiao
- Shaanxi Provincial Clinical Research Center for Ophthalmic Diseases, Xi'an City First Hospital, Xi'an, China
- Shaanxi Key Laboratory of Ophthalmology, Shaanxi Institute of Ophthalmology, Xi'an, China
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4
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Zhang L, Wang J, Gao Y. Eyelid cleaning: Methods, tools, and clinical applications. Indian J Ophthalmol 2023; 71:3607-3614. [PMID: 37991291 PMCID: PMC10788755 DOI: 10.4103/ijo.ijo_1457_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/25/2023] [Indexed: 11/23/2023] Open
Abstract
Nowadays, people give more importance and pay closer attention to the condition of their eyelids and lid margins. This increased recognition of eyelid hygiene is due to the growing awareness that improper eyelid cleaning might lead to various ocular surface diseases such as blepharitis and meibomian gland dysfunction. These ocular surface diseases can greatly affect people's quality of life. This article reviews the latest procedures for proper eyelid cleaning, including indications, methods, tools, detergents, and clinical applications, to maintain a healthy ocular surface and assist in the treatment of dry eye and blepharitis.
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Affiliation(s)
- Ling Zhang
- Department of Ophthalmology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian Province, China
| | - Jingru Wang
- Department of Ophthalmology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian Province, China
| | - Yingying Gao
- Department of Ophthalmology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian Province, China
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5
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Gomes JAP, Azar DT, Baudouin C, Bitton E, Chen W, Hafezi F, Hamrah P, Hogg RE, Horwath-Winter J, Kontadakis GA, Mehta JS, Messmer EM, Perez VL, Zadok D, Willcox MDP. TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface. Ocul Surf 2023; 29:331-385. [PMID: 37087043 DOI: 10.1016/j.jtos.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), Sao Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Christophe Baudouin
- Quinze-Vingts National Eye Hospital & Vision Institute, IHU FOReSIGHT, Paris, France
| | - Etty Bitton
- Ecole d'optométrie, Université de Montréal, Montréal, Canada
| | - Wei Chen
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Pedram Hamrah
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ruth E Hogg
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | | | | | | | | | - Victor L Perez
- Foster Center for Ocular Immunology, Duke University Eye Center, Durham, NC, USA
| | - David Zadok
- Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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6
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Kudasiewicz-Kardaszewska A, Grant-Kels JM, Grzybowski A. Meibomian gland dysfunction and blepharitis: A common and still unsolved ophthalmic problem. Clin Dermatol 2023; 41:491-502. [PMID: 37574151 DOI: 10.1016/j.clindermatol.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Blepharitis and meibomian gland dysfunction (MGD) are very common, usually underdiagnosed and underappreciated diseases. More than 50% of patients seeking ophthalmologic consultations have symptoms and signs indicating one or both entities. We summarize the key points of diagnosis and management of both diseases, comparing the work of Dry Eye Workshop II (2017) with the dry eye blepharitis syndrome unification theory. The impact of MGD/blepharitis on ocular surgery also is described. Although MGD and blepharitis seem to be uncurable, most of the time they can be successfully controlled. Different management options are available, but the key to success remains simple-routine eyelid hygiene and moisturizing with the use of preservative-free lubricants.
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Affiliation(s)
| | - Jane M Grant-Kels
- Dermatology Department, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Institute for Research in Ophthalmology, Poznań, Poland
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Sullivan DA, da Costa AX, Del Duca E, Doll T, Grupcheva CN, Lazreg S, Liu SH, McGee SR, Murthy R, Narang P, Ng A, Nistico S, O'Dell L, Roos J, Shen J, Markoulli M. TFOS Lifestyle: Impact of cosmetics on the ocular surface. Ocul Surf 2023; 29:77-130. [PMID: 37061220 DOI: 10.1016/j.jtos.2023.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Abstract
In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.
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Affiliation(s)
| | | | - Ester Del Duca
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | | | - Sihem Lazreg
- Lazreg Cornea and Ocular Surface Center, Blida, Algeria
| | - Su-Hsun Liu
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | | | - Alison Ng
- Centre for Ocular Research & Education, School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Steven Nistico
- Department of Dermatology, University Magna Graecia, Catanzaro, Italy
| | | | | | - Joanne Shen
- Department of Ophthalmology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Maria Markoulli
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
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8
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Andreas M, Fabczak-Kubicka A, Schwartz RA. Ocular rosacea: an under-recognized entity. Ital J Dermatol Venerol 2023; 158:110-116. [PMID: 37153945 DOI: 10.23736/s2784-8671.23.07484-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
While rosacea is a common dermatologic condition, ocular rosacea is sometimes evident either with cutaneous rosacea or occasionally by itself. Manifesting with such varied symptoms as dry eye, Meibomian gland dysfunction, and corneal erosion, ocular rosacea can be confused with a multitude of other diseases. While ocular rosacea is commonly mild and rarely severe, physicians should still expand their examination to include ocular manifestations of rosacea. In addition, we propose diagnostic criteria for ocular rosacea, stressing the importance of early recognition and treatment.
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Affiliation(s)
| | | | - Robert A Schwartz
- Dermatology, Pathology and Pediatrics, Rutgers New Jersey Medical School, Newark, NJ, USA -
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9
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Zhang H, Wu Y, Wan X, Shen Y, Le Q, Yang P, Zhou S, Zhou X, Zhou F, Gu H, Hong J. Effect of Hypochlorous Acid on Blepharitis through Ultrasonic Atomization: A Randomized Clinical Trial. J Clin Med 2023; 12:jcm12031164. [PMID: 36769811 PMCID: PMC9917691 DOI: 10.3390/jcm12031164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/14/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of eyelid hygiene using topical 0.01% hypochlorous acid (HOCL) through ultrasonic atomization after 2 weeks in patients with blepharitis. DESIGN Randomized controlled trial. METHODS Patients with blepharitis were randomized into two groups: topical 0.01% HOCL through ultrasonic atomization (HOCL group, 42 eyes) or eyelid scrubs (control group, 37 eyes). Patients in both groups received warm compresses twice daily and topical 0.5% levofloxacin three times a day. Primary outcomes were the ocular surface disease index scores (OSDI), lid margin redness, lid margin abnormalities, meibum expressibility, meibum quality, and noninvasive breakup time after 2 weeks. Secondary outcomes were conjunctiva redness, corneal fluorescein staining, and tear meniscus height. A questionnaire of treatment adherence with a free response section was administered to confirm patient compliance and comments. RESULTS Sixty-seven participants participated in this study. Both groups show an improvement in all primary outcomes, while statistically significant improvements in OSDI, lid margin redness, lid margin abnormality, meibum expressibility and quality are only limited to the HOCL group after 2 weeks of treatment (p < 0.05, p < 0.05, p < 0.001, p < 0.001 and p < 0.001, respectively). Subgroup analysis in HOCL reveals that only the change in lid margin abnormality and meibum expressibility in the mild-moderate meibomian glands loss patients at baseline has a statistically significant difference p < 0.05). Multiple linear regression shows that the improvement in OSDI is negatively associated with meibum expressibility score at the baseline (95% CI [-28.846, -1.815], p = 0.028). The patient compliance is 7.1 ± 2.0 in the HOCL group and 7.1 ± 1.8 in the control group (p > 0.05). No adverse events are reported. CONCLUSION Topical 0.01% HOCL through ultrasonic atomization is a tolerable and effective eyelid hygiene treatment for blepharitis.
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Affiliation(s)
- Hong Zhang
- Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China
| | - Yuqing Wu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China
| | - Xichen Wan
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China
| | - Yan Shen
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China
| | - Qihua Le
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China
| | - Pei Yang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China
| | - Shuyun Zhou
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China
| | - Xujiao Zhou
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China
| | - Feng Zhou
- Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Hao Gu
- Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Jiaxu Hong
- Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200437, China
- Correspondence:
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Mohammad-Rabei H, Arabi A, Shahraki T, Rezaee-Alam Z, Baradaran-Rafii A. Role of Blepharoexfoliation in Demodex Blepharitis: A Randomized Comparative Study. Cornea 2023; 42:44-51. [PMID: 35439775 DOI: 10.1097/ico.0000000000003046] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/07/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and efficacy of blepharoexfoliation in the treatment of Demodex blepharitis. METHODS Patients with microscopically approved Demodex blepharitis were enrolled. Patients in the treatment group were treated once with in-office blepharoexfoliation (BlephEx LLC; Franklin, TN) using tea tree oil 2% shampoo, followed by eyelid scrubs with tea tree oil 2% shampoo twice a day for 8 weeks. Patients in the control group were treated with the same protocol, except for the in-office sham blepharoexfoliation procedure. As the main outcome measurement, the changes in the severity of symptoms [Ocular Surface Disease Index (OSDI) score] were compared. The changes in Demodex count and meibomian gland dysfunction (MGD) severity were compared as the secondary outcome measurements. RESULTS Eighty-one patients (36 male and 45 female) were included. The mean age of the patients was 53.56 ± 8.13 years. The mean baseline OSDI score was 33.30 ± 11.80. The mean baseline Demodex count was 4.84 ± 1.49. The Demodex count at the baseline visit was moderately correlated with the baseline OSDI score (R = 0.526, P = 0.011) and baseline MGD severity ( P = 0.02). At the 8-week visit, the OSDI score was 22.62 ± 8.23 and 27.09 ± 9.11 in the blepharoexfoliation and control groups, respectively ( P = 0.016). At the 8-week visit, the Demodex count was 2.6 ± 1.08 and 3.03 ± 1.27 in the treatment and control groups, respectively ( P = 0.025). MGD improved in both groups ( P = 0.84). In the blepharoexfoliation group, the change in the OSDI score was moderately correlated with the baseline OSDI score (R = 0.611, P = 0.01). CONCLUSIONS One session of blepharoexfoliation, followed by manual eyelid scrubs was more effective than eyelid scrubs alone in reducing patients' symptoms and Demodex count.
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Affiliation(s)
- Hossein Mohammad-Rabei
- Department of Ophthalmology, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and
| | - Amir Arabi
- Department of Ophthalmology, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and
| | - Toktam Shahraki
- Department of Ophthalmology, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and
| | - Zahra Rezaee-Alam
- Department of Ophthalmology, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and
| | - Alireza Baradaran-Rafii
- Department of Ophthalmology, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL
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11
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Ye Q, Yan W, Wang Y, Chen M. The prevalence of ocular Demodex folliculorum in 2253 young males. Sci Rep 2022; 12:22346. [PMID: 36572737 PMCID: PMC9792446 DOI: 10.1038/s41598-022-26782-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
To investigate the prevalence and influencing factors of Demodex folliculorum (DF) in the eyelashes of healthy young males. An epidemiological cross-sectional prevalence study was conducted. We conducted visual acuity, eye-related examination, eyelash microscopic examination and DF count of recruits in Fujian Province in 2019. The presence of DF was analyzed according to age, keratorefractive surgery, annual household income, educational level, long-term residence, sleep time, time of using electronic products, smoking and drinking habit. A total of 2253 healthy young males (aged 17-24 years) were studied for the presence of DF within eyelash follicles. The total prevalence of DF was 20.73% in our study. Subjects with history of keratorefractive surgery had a statistically significant increase in the prevalence of DF (P < 0.001). The prevalence of DF was higher in subjects with ocular symptoms than in those without symptoms (P < 0.05). Factors such as the educational level and so on we analyzed had no significant correlation with the prevalence of DF (all P > 0.05). According to the multivariate logistic regression analysis, the history of keratorefractive surgery was the risk factors of DF infection (P < 0.001), and the risk of infection was 1.437 times higher in the population with the history of keratorefractive surgery than in the population without. There was no correlation between ocular discomfort and DF infection (P > 0.05). The prevalence of DF in eyelash follicles in healthy young males was relatively high. The history of keratorefractive surgery was an important risk factor for the infection.
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Affiliation(s)
- Qian Ye
- grid.12955.3a0000 0001 2264 7233Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hospital Affiliated to Xiamen University), Fuzhou, 350025 China
| | - Weiming Yan
- grid.12955.3a0000 0001 2264 7233Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hospital Affiliated to Xiamen University), Fuzhou, 350025 China
| | - Yunpeng Wang
- grid.12955.3a0000 0001 2264 7233Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hospital Affiliated to Xiamen University), Fuzhou, 350025 China
| | - Meizhu Chen
- grid.12955.3a0000 0001 2264 7233Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hospital Affiliated to Xiamen University), Fuzhou, 350025 China
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12
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Lee YI, Seo M, Cho KJ. Demodex Blepharitis: An Analysis of Nine Patients. THE KOREAN JOURNAL OF PARASITOLOGY 2022; 60:429-432. [PMID: 36588421 PMCID: PMC9806504 DOI: 10.3347/kjp.2022.60.6.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/05/2022] [Indexed: 12/29/2022]
Abstract
Inflammatory eyelid symptoms are common in primary care and there have been several reports on Demodex blepharitis. In the present study, we evaluate the 9 patients with Demodex blepharitis, who showed inflammation of the eyelids, dry eye, and cylindrical dandruff at the base of the eyelashes. The causative species from all patients was Demodex folliculorum of either the adult or nymph stage. Two patients had recurrent chalazion and 3 patients had keratitis. Weekly lid scrubs with 50% tee tree oil were performed for 6 weeks. After treatment, the symptoms of blepharitis and keratitis had improved in all patients. This case report provides clinical reference source for the proper treatment of ocular demodicosis.
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Affiliation(s)
- Young Il Lee
- Department of Anatomy, College of Medicine, Dankook University, Cheonan 31116,
Korea
| | - Min Seo
- Department of Parasitology, College of Medicine, Dankook University, Cheonan 31116,
Korea
| | - Kyong Jin Cho
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan 31116,
Korea,Corresponding author ()
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Vishwakarma P, Murthy SI, Sharma S, Bagga B. Varied presentations of ocular demodicosis in a rural population. BMJ Case Rep 2022; 15:e252704. [PMID: 36167429 PMCID: PMC9516173 DOI: 10.1136/bcr-2022-252704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | | | - Savitri Sharma
- Jhaveri Microbiology Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Bhupesh Bagga
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Uneven Meibomian Gland Dropout in Patients with Meibomian Gland Dysfunction and Demodex Infestation. J Clin Med 2022; 11:jcm11175085. [PMID: 36079014 PMCID: PMC9457096 DOI: 10.3390/jcm11175085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to compare the differences between uneven meibomian gland (MG) atrophy with and without Demodex infestation based on the index of uneven atrophy score (UAS). In this retrospective cohort study, 158 subjects were recruited, including 66 subjects in the Demodex-positive MGD group, 49 subjects in the Demodex-negative MGD group, and 43 subjects as normal control. No significant difference was verified in OSDI, TMH, TBUT, CFS, lid margin score, and meibograde (all p > 0.05) between the Demodex-positive MGD group and the Demodex-negative MGD group. The UAS index of the upper eyelid or both eyelids was significantly higher in the Demodex-positive group in comparison with the normal control group and Demodex-negative group and the difference was statistically significant between the three groups. The UAS was significantly positive correlation with OSDI (r = 0.209, p < 0.05), lid margin score (r = 0.287, p < 0.001), and meibograde (r = 0.356, p < 0.001), which has a significant negative correlation with TBUT (r = −0.248, p < 0.05). Thus, Demodex infestation can cause uneven MG atrophy and we propose a novel index of UAS, which is used to evaluate uneven atrophy of MGs and as a morphological index of Demodex infestation.
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Antiparasitic Activity of Tea Tree Oil (TTO) and Its Components against Medically Important Ectoparasites: A Systematic Review. Pharmaceutics 2022; 14:pharmaceutics14081587. [PMID: 36015213 PMCID: PMC9416580 DOI: 10.3390/pharmaceutics14081587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/14/2022] [Accepted: 07/22/2022] [Indexed: 12/04/2022] Open
Abstract
Ectoparasites are pathogens that can infect the skin and cause immense pain, discomfort, and disease. They are typically managed with insecticides. However, the fast-emerging antimicrobial resistance and the slow rate of development of new bio-actives combined with environmental and health concerns over the continued use of neurotoxic insecticides warrant newer and alternative methods of control. Tea tree oil (TTO), as an alternative agent, has shown remarkable promise against ectoparasites in recent studies. To our knowledge, this is the first systematic review to assess preclinical and clinical studies exploring the antiparasitic activity of TTO and its components against clinically significant ectoparasites, such as Demodex mites, scabies mites, house dust mites, lice, fleas, chiggers, and bed bugs. We systematically searched databases, including PubMed, MEDLINE (EBSCOhost), Embase (Scopus), CENTRAL, Cochrane Library, CINAHL, ScienceDirect, Web of Science, SciELO, and LILACS in any language from inception to 4 April 2022. Studies exploring the therapeutic activity of TTO and its components against the ectoparasites were eligible. We used the ToxRTool (Toxicological data reliability assessment) tool, the Joanna Briggs Institute (JBI) critical appraisal tools, and the Jadad scale to assess the methodological qualities of preclinical (in vitro and in vivo) studies, non-randomised controlled trials (including cohort, case series, and case studies), and randomised controlled trials, respectively. Of 497 identified records, 71 studies were included in this systematic review, and most (66%) had high methodological quality. The findings of this review revealed the promising efficacy of TTO and its components against ectoparasites of medical importance. Most importantly, the compelling in vitro activity of TTO against ectoparasites noted in this review seems to have translated well into the clinical environment. The promising outcomes observed in clinical studies provide enough evidence to justify the use of TTO in the pharmacotherapy of ectoparasitic infections.
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Huang J, Guo MX, Xiang DM, Yan LF, Yu Y, Han L, Wang JX, Lu XH. The association of demodex infestation with pediatric chalazia. BMC Ophthalmol 2022; 22:124. [PMID: 35291979 PMCID: PMC8925234 DOI: 10.1186/s12886-022-02261-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/12/2022] [Indexed: 01/18/2023] Open
Abstract
Purpose This study aimed to investigate the association of Demodex infestation with pediatric chalazia. Methods In a prospective study, 446 children with chalazia and 50 children with non-inflammatory eye disease (controls) who underwent surgical treatment were enrolled from December 2018 to December 2019. Patient ages ranged from 7 months to 13 years old. All patients underwent eyelash sampling for light microscope examination, and statistical correlation analysis between Demodex infestation and chalazia, including the occurrence, recurrence, and course of disease, morphological characteristics, and meibomian gland dysfunction (MGD) in chalazia patients was performed. Results Demodex was found in 236 (52.91%) patients with chalazia and zero control patients. Demodicosis was significantly more prevalent in chalazia patients than the control group (P < 1 × 10− 14). Recurrent chalazia (P = 0.006) and skin surface involvement (P = 0.029) were highly correlated with Demodex infestation. Demodicosis was also associated with multiple chalazia (P = .023) and MGD(P = .024). However, Demodex infestation was comparable in the course of disease (P = 0.15), seasonal change (P = 0.68) and blepharitis subgroups (P = 0.15). Within the group of chalazia patients who underwent surgical removal of cysts, 4 (0.9%) patients with concurrent demodicosis experienced recurrence. Conclusions Demodex infestation was more prevalent in pediatric chalazia patients than healthy children, and was associated with recurrent and multiple chalazia. Demodicosis should be considered as a risk factor of chalazia. In children with chalazia, Demodex examination and comprehensive treatment of Demodex mites should be applied to potentially prevent recurrence.
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Affiliation(s)
- Jing Huang
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong Province, China.,Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, Guangdong Province, China
| | - Meng-Xiang Guo
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, Guangdong Province, China
| | - Dao-Man Xiang
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, Guangdong Province, China
| | - Li-Feng Yan
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, Guangdong Province, China
| | - Ying Yu
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, Guangdong Province, China
| | - Ling Han
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, Guangdong Province, China
| | - Jian-Xun Wang
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, Guangdong Province, China
| | - Xiao-He Lu
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong Province, China.
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Forton FM. Rosacea, an infectious disease: why rosacea with papulopustules should be considered a demodicosis. A narrative review. J Eur Acad Dermatol Venereol 2022; 36:987-1002. [DOI: 10.1111/jdv.18049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
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Hao Y, Zhang X, Bao J, Tian L, Jie Y. Demodex folliculorum Infestation in Meibomian Gland Dysfunction Related Dry Eye Patients. Front Med (Lausanne) 2022; 9:833778. [PMID: 35280856 PMCID: PMC8907481 DOI: 10.3389/fmed.2022.833778] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo report the influence of Demodex folliculorum (D. folliculorum) infestation in patients with meibomian gland dysfunction (MGD) related dry eye and the associations of the infestation with MGD related dry eye.MethodsEyelashes (three from the upper eyelid and three from the lower eyelid) from 119 eyes of 119 patients diagnosed with MGD related dry eye were examined under a light microscope. There were 68 eyes of 68 patients with MGD related dry eye and D. folliculorum infestation (Demodex positive group) and 51 eyes of 51 patients without infestation (Demodex negative group). All patients completed an Ocular Surface Disease Index (OSDI) questionnaire and underwent tests for dry eye and MGD. The tests included fluorescein tear breakup time (TBUT), corneal fluorescein staining, Schirmer I test (SIT), lid margin abnormalities, meibum expression assessment, and meibomian gland dropout.ResultsThe scores for OSDI, corneal fluorescein staining, lid margin abnormalities, meibum expression, and meibomian gland dropout were significantly higher (all P < 0.05), while TBUT was significantly shorter in the Demodex positive group compared to the Demodex negative group (P = 0.020). The SIT values did not significantly differ between groups. Chalazion was significantly more prevalent in the Demodex positive group. The number of D. folliculorum was positively correlated with all three MGD parameters (P ≤ 0.035), OSDI; corneal fluorescein scores, and it was inversely correlated with BUT. The correlation for SIT was R2 = 0.075 (P = 0.064).ConclusionDemodex folliculorum infestation is possibly one of the key contributors in the pathogenesis of MGD related dry eye, and a higher prevalence of chalazion was found in D. folliculorum infected patients. The possible causal role of D. folliculorum infestation needs to be further studied.
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Affiliation(s)
- Yiran Hao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jiayu Bao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lei Tian
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University & Capital Medical University, Beijing, China
- Lei Tian
| | - Ying Jie
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Ying Jie
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Hypochlorous Acid Can Be the Novel Option for the Meibomian Gland Dysfunction Dry Eye through Ultrasonic Atomization. DISEASE MARKERS 2022; 2022:8631038. [PMID: 35035613 PMCID: PMC8754612 DOI: 10.1155/2022/8631038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/11/2021] [Accepted: 12/17/2021] [Indexed: 01/09/2023]
Abstract
Background Dry eye is a multifactor disease which needs comprehensive treatments to keep the homeostasis of ocular surface. Objective To explore the effect of hypochlorous acid on the meibomian gland dysfunction dry eye through ultrasonic atomization. Methods We set this study of 0.01% HOCL and 0.1% hyaluronate by ultrasonic atomization. All the data was recorded at the 1st, 15th, 30th, and 55th days. The patients' complains, the meibum analysis, conjunctive congestion, corneal staining, Schirmer's I test, and NIBUT were recorded by K5M, the MMP-9, and IL-2 of tear by inflammation kit; the Demodex was recorded by microscopy. Results 53 patients have joined this study. There is no statistic difference between them on OSDI (day 15: p = 0.061, 30: p = 0.055, 55: p = 0.052); results show the 10.57 ± 0.13 and 12.54 ± 0.17 reduction on OSDI; the differences of both treatments are significant (∗∗p < 0.01). Increased Schirmer's and TBUT are 3.27 ± 0.10 and 6.29 ± 0.10 (∗∗p < 0.01) or 7.32 ± 1.72 s and 9.22 ± 1.41 s (∗p < 0.05); the decreased conjunctive and corneal staining are 0.23 ± 0.07 and 0.45 ± 0.06 (∗∗p < 0.01) or 0.42 ± 0.03 and 0.37 ± 0.02 (∗p < 0.05) at both groups. The differences of MMP-9 and IL-2 negative rate are significant (Z = 0.896, ∗∗p = 0.002 < 0.01; Z = 0.659, ∗∗p = 0.001 < 0.01); the number of Demodex mites at first is 10 or 11, while the last is 2 or 6 (Z = −4.642, ∗∗p < 0.01; Z = 2.742, p > 0.05). The Demodex count between them is significant (Z = −2.310, ∗p = 0.032 < 0.05). The survival times (ST) of each stage at the HOCL are 110.75 (108.50 ± 24.50), 95.50 (90.25 ± 14.50), and 75.25 (73.48 ± 8.50) min which are shorter than those of control which are 155.50 (160.10 ± 21.50), 130.25 (128.25 ± 16.50), and 105.75 (102.50 ± 14.50) min (∗∗p < 0.01). The Demodex eradication rate of HOCL is statistic significant (∗p15th vs. 1stday = 0.028 < 0.05; ∗∗p30th vs. 1stday = 0.002 < 0.01; ∗∗p55th vs. 1stday = 0.0018 < 0.01). Conclusions 0.01% HOCL improves the Demodex eradication by shortening the survival time; the HOCL acts on the ocular surface by reducing the inflammation. The ultrasonic atomization helps for the drug usage.
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The Ocular Surface Characteristics in Prostate Cancer Patients Treated with Androgen Deprivation Therapy. DISEASE MARKERS 2021; 2021:5390195. [PMID: 34795806 PMCID: PMC8595033 DOI: 10.1155/2021/5390195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/22/2021] [Indexed: 12/03/2022]
Abstract
Background To investigate the association of long-term androgen deprivation therapy (ADT) with ocular surface characteristics in prostate cancer patients. Methods A total of 30 male prostate cancer patients who received ADT were selected. All candidates were scored using the Ocular Surface Disease Index (OSDI) and subsequently divided into two groups containing 9 symptomatic patients (scores >12) and 21 asymptomatic patients (scores ≤ 12). Another 20 healthy age-matched males were selected as the control group. Each candidate was assessed with respect to eyelid margin abnormality, tear film break-up time (NI-BUT), tear meniscus height (TMH), meiboscore, meibum expressibility, and demodex infection. Results The NI-BUT in the ADT group was significantly shorter than that in the control group. The scores for OSDI, eyelid margin abnormality, meibum expressibility, and meiboscores were significantly higher in the ADT group (P < 0.05). Moreover, the NI-BUT in the symptomatic ADT group was significantly shorter than that in the asymptomatic ADT group (P < 0.05). The meiboscores and meibum expressibility score in the symptomatic ADT group were significantly higher than those in the asymptomatic ADT group (P < 0.05). The presence of demodex in the symptomatic ADT group was also higher than that in the asymptomatic ADT group (P < 0.05).The length of time that patients had been taking ADT was positively correlated with meiboscores and negatively correlated with NI-BUT. Conclusion Androgen levels were associated with significant changes in relative meibomian gland function. Subjective symptoms, such as dryness and foreign body sensation, were more obvious in prostate cancer patients receiving ADT, which may be caused by MGD and demodex infection. It's recommended that more attention be paid to the ocular surface in prostate cancer patients taking ADT by performing examination of NI-BUT and meibomian gland morphology and function with a view to providing more comprehensive prevention and treatment protocols.
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Update on the Management and Treatment of Demodex Blepharitis. Cornea 2021; 41:934-939. [PMID: 34743107 DOI: 10.1097/ico.0000000000002911] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/12/2021] [Indexed: 10/19/2022]
Abstract
ABSTRACT Demodex blepharitis is a common ophthalmologic disease that is often overlooked in the workup of blepharitis. Demodex infestation occurs in both symptomatic and asymptomatic individuals at similar rates; consequently, its role in the development of blepharitis has not been well elucidated. Two species have been confirmed to inhabit the human eyelid-Demodex folliculorum and Demodex brevis. These species differ in their preferred location of infestation, with D. folliculorum occupying the base of the eyelash and D. brevis inhabiting the meibomian glands, contributing to anterior and posterior Demodex blepharitis, respectively. A clinical index of suspicion must be developed from the history when blepharitis, conjunctivitis, or keratitis in adults and blepharoconjunctivitis or chalazia in children are resistant to treatment. The diagnosis can be strongly suspected by the presence of cylindrical dandruff at the base of the eyelash and confirmed by light microscopy of an epilated lash or by in vivo confocal microscopy. No cure is currently available. Management most frequently includes topical tea tree oil and its active ingredient terpinen-4-ol, both of which have produced good clinical outcomes. Topical tea tree oil is typically applied by a professional due to risk of toxicity. Several second-line treatment options have been studied, including ivermectin, metronidazole, selenium sulfide, microblepharoexfoliation, and lid hygiene. Novel, targeted therapies such as TP-03 (Tarsus Pharmaceuticals) are also currently being investigated in phase 2b/3 clinical trials. The purpose of this review purpose is to characterize Demodex blepharitis in detail, including its historical perspective and various classifications, and describe the latest diagnostic and management strategies.
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Clinical characteristics of Demodex-associated recurrent hordeola: an observational, comparative study. Sci Rep 2021; 11:21398. [PMID: 34725365 PMCID: PMC8560857 DOI: 10.1038/s41598-021-00599-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/05/2021] [Indexed: 11/08/2022] Open
Abstract
Our study evaluated the association between Demodex infestation and recurrent hordeola and examined the clinical features associated with these eyelid lesions. This was an observational, comparative study. We reviewed 250 patients and divided them into the recurrent hordeolum (n = 153) and control (n = 97) groups. Demodex infestation was detected by epilating eyelashes around the lesion/s and viewing them under a light microscope. Patient medical records and photographs were retrospectively analyzed to identify the clinical characteristics of Demodex-associated recurrent hordeola. Demodex was detected in 91 (59.5%) and 17 (17.5%) patients in the recurrent hordeolum and control groups (p < 0.001), respectively. In the recurrent hordeolum group, Demodex mites were found in 74 (68.5%) and 17 (37.8%) of the adult and pediatric patients (p < 0.001), respectively. Among patients with recurrent hordeola, patients in their 20s were most likely to have concomitant Demodex infestation. Patients with Demodex infestations were also more likely to develop recurrent lesions within a shorter period of time from the primary incision and curettage. The most common presentation of Demodex-associated recurrent lesions was external hordeola (67%) (p = 0.002). Demodex infestation may cause recurrent hordeola in adults and children. These mites may play a greater role in the development of lesions in adult patients. The strongest association between Demodex infestation and recurrent lesions was seen in patients in their 20s. Our results suggest that if the hordeola recur within a short period of time with the clinical characteristics of external location of eyelid, multiple numbers of lesions, or anterior blepharitis, eyelash epilation should be performed to identify the presence of Demodex mites.
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Safety and Efficacy of Topical Lotilaner Ophthalmic Solution 0.25% for the Treatment of Demodex Blepharitis: A Pilot Study. J Ophthalmol 2021; 2021:3862684. [PMID: 34603770 PMCID: PMC8481060 DOI: 10.1155/2021/3862684] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/24/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Evaluate safety and efficacy of topical lotilaner ophthalmic solution, 0.25% for the treatment of Demodex blepharitis. Patients and Methods. 15 patients with Demodex blepharitis, defined as >10 collarettes on the upper lid, lid margin erythema, and Demodex density of ≥1.5 mites/lash on microscopy, were treated bid for 28 days with lotilaner ophthalmic solution, 0.25%. Contact lens wear, artificial eyelashes, and lid structural abnormalities were among the exclusion criteria. No other antibacterial, antiparasitic, or anti-inflammatory treatment or lid hygiene products were permitted. Patients were assessed on Days 7, 14, 28, 60, and 90. Outcome measures were changes in collarette grade and mite density on Day 28. Adverse events and changes in intraocular pressure (IOP), corrected distance visual acuity (CDVA), and slit-lamp biomicroscopy were assessed. Results Mean collarette grade (upper lids) improved from 3.07 ± 0.21 to 0.79 ± 0.19 on Day 28; the change was statistically significant for both upper and lower lids from Day 14 on. Mean mite density per lash decreased from 2.28 ± 0.16 at baseline to 0.14 ± 0.05 at Day 28 (p < 0.0001). Mite eradication (0 mites) was documented in 57.1% of eyes. The effects were durable through Day 90. There were no adverse events and little to no change in CDVA or IOP. The drop was well tolerated, with no discontinuations due to ocular irritation. Conclusion Topical lotilaner ophthalmic solution, 0.25% for 4 weeks, showed promising efficacy for the treatment of Demodex blepharitis. This novel treatment appears to be safe and well tolerated. Randomized controlled studies are needed to confirm the results.
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Tharmarajah B, Coroneo MT. Corneal Effects of Tea Tree Oil. Cornea 2021; 40:1363-1364. [PMID: 34074891 DOI: 10.1097/ico.0000000000002776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study is to report a case of corneal epithelial defects resulting from topical treatment of blepharitis with tea tree oil (TTO). METHODS A 44-year-old man with a 1 year history of blepharitis non-responsive to eyelid hygiene was found to have signs of Demodex infestation. He was treated with a topical, off-label 50% TTO solution. Shortly afterward, the patient complained of bilateral ocular discomfort. RESULTS Slit-lamp examination revealed conjunctival injection and a corneal epithelial defect in both eyes. Treatment with lubricant, antibiotic, and steroid eye drops as well as bandage contact lenses was required to facilitate corneal healing. CONCLUSIONS Topical use of off-label, 50% concentration TTO can result in corneal epithelial defects. Eye care professionals should remain aware of this risk and only use approved, low-concentration TTO products when treating Demodex-related blepharitis.
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Affiliation(s)
| | - Minas Theodore Coroneo
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia; and
- University of New South Wales, Sydney, Australia
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Zarei-Ghanavati S, Nooghabi MJ, Zamani G. Comparison of the Effect of Tea Tree Oil Shampoo With Regular Eyelid Shampoo in Meibomian Gland Dysfunction Treatment. Am J Ophthalmol 2021; 229:45-51. [PMID: 33905746 DOI: 10.1016/j.ajo.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/05/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study is aimed at comparing the effects of tea tree oil (TTO) shampoo with regular eyelid shampoo on the treatment of meibomian gland dysfunction (MGD) signs and symptoms. DESIGN Double-masked randomized clinical trial METHODOLOGY: Forty patients with MGD were treated by daily eyelid scrubbing with TTO shampoo in one eye and regular eyelid shampoo in the other one. Before treatment and then after 1 and 3 months, the effect on ocular surface symptoms, tear production and stability, and conjunctival and eyelid signs of the 2 eyes were compared. RESULTS Plugging and capping of meibomian gland orifices, foamy tear, glands expressibility, 5-Item Dry Eye Questionnaire score (DEQ5), and tear breakup time were improved more significantly in TTO shampoo-treated eyes (capping P = .050, plugging and glands expressibility P = .001, others P < .001). In spite of improvement in both eyes, scores of meibum quality, conjunctival hyperemia, corneal and conjunctival staining, and Schirmer1 test value showed no statistically significant difference between the eyes (P = .06, .187, .192, .19, respectively). Moreover, eyelid margin telangiectasia resolved only in TTO shampoo-treated eyes (P < .001). Trichiasis and distichiasis changed in neither group (P > .99). Furthermore, ocular surface irritation during scrubbing was more common with TTO shampoo (P = .002). CONCLUSION TTO shampoo was found to be more efficient than regular eyelid shampoo in controlling MGD signs and symptoms although ocular surface irritation during its application was more frequent.
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Gonzalez-Salinas R, Yeu E, Holdbrook M, Baba SN, Ceballos JC, Massaro-Corredor M, Corredor-Ortega C, Ramos-Betancourt N, Quiroz-Mercado H. Collarette Elimination and Demodex Mite Eradication with Topical Lotilaner Ophthalmic Solution, 0.25. J Ocul Pharmacol Ther 2021; 37:479-484. [PMID: 34415795 DOI: 10.1089/jop.2021.0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Purpose: To evaluate the efficacy of topical lotilaner ophthalmic solution, 0.25%, in patients with Demodex blepharitis. Methods: Eighteen adults with Demodex blepharitis, defined as >10 collarettes on the upper lid and/or mite density of ≥1.5 mites per lash (upper and lower), were treated bid for 42 days with the topical lotilaner ophthalmic solution, 0.25%. Contact lens wear, artificial eyelashes, and lid structural abnormalities were among the exclusion criteria. No other antibacterial, antiparasitic, or anti-inflammatory treatment or lid hygiene products were permitted. One eye of each patient was selected for analysis and assessed on day 7, 14, 28, and 42. Collarettes were graded at each visit, and mite density was evaluated by microscopy at each visit except day 7. Outcome measures were collarette elimination (≤2 lashes with collarettes) and mite eradication (0 mites). Drop tolerability, adverse events, visual acuity, and slit-lamp biomicroscopy were assessed. Results: Collarette elimination was achieved in 13/18 participants (72.2%) by day 42. Mean collarette grade (upper lid) declined from 3.56 ± 0.17 to 0.28 ± 0.11. Mite eradication was achieved in 14/18 participants (77.8%) by day 42. Mean mite density decreased from 2.63 ± 0.39 to 0.12 ± 0.08 mites/lash. Participants reported good tolerability. Adverse events were mild and transient and did not result in treatment discontinuation. Conclusion: Six weeks of at-home topical therapy with the lotilaner ophthalmic solution, 0.25%, was effective in eliminating the most common objective signs of Demodex blepharitis, with a collarette elimination rate of 72% and mite eradication in 78% of eyes by day 42. ISRCTN registration #: 24398865.
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Salinas RG, Karpecki P, Yeu E, Holdbrook M, Baba SN, Ceballos JC, Massaro-Corredor M, Corredor-Ortega C, Ramos-Betancourt N, Quiroz-Mercado H. Safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to demodex infestation: A randomized, controlled, double-masked clinical trial. Cont Lens Anterior Eye 2021; 45:101492. [PMID: 34332895 DOI: 10.1016/j.clae.2021.101492] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to Demodex infestation compared to vehicle control. METHODS In this phase II, randomized, controlled, double-masked clinical trial, 60 eligible participants with Demodex blepharitis were randomly assigned in a 1:1 ratio to receive either topical lotilaner ophthalmic solution, 0.25% (Tarsus Pharmaceuticals, Inc., Irvine, CA) (study group) or the vehicle without lotilaner (control group) bilaterally twice a day for 28 days. Participants were followed at Days 7, 14, 28, 60 and 90. The efficacy parameters were change in collarette grade and Demodex density at Day 28. Safety parameters were adverse events, changes in corrected distance visual acuity (CDVA), intraocular pressure (IOP) and slit-lamp biomicroscopy. RESULTS The study group showed a statistically significant decrease in collarette grade compared to the control group beginning at Day 14 (p = 0.003) in the upper eyelid and at Day 28 (p = 0.003) in the lower eyelid. Decreases in both lids were maintained through Day 90 (p < 0.001). At Day 28, mite eradication was achieved in 66.7% and 25.9% of eyes in the study and control group (p = 0.005); at Day 90, these proportions were 68.2% and 18.5% (p = 0.001), respectively. No serious adverse events or clinically significant changes in CDVA and IOP were observed. CONCLUSION For Demodex blepharitis, treatment with lotilaner ophthalmic solution, 0.25% for 4 weeks is safe and effective. The improvement in collarette grade and mite density observed during the treatment period persisted for at least two months following treatment cessation.
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Efficacy of Topical Ivermectin 1% in the Treatment of Demodex Blepharitis. Cornea 2021; 41:427-434. [PMID: 34173370 PMCID: PMC8895970 DOI: 10.1097/ico.0000000000002802] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/28/2021] [Indexed: 12/04/2022]
Abstract
The purpose of this study was to evaluate the efficacy of topical ivermectin 1% cream application on the eyelashes in combination with eyelid hygiene in the treatment of Demodex blepharitis.
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Massive Demodicosis of the Eyes in a Patient with Sjögren Syndrome: A Case Report. Acta Parasitol 2021; 66:677-681. [PMID: 33128728 PMCID: PMC8166728 DOI: 10.1007/s11686-020-00297-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/07/2020] [Indexed: 12/16/2022]
Abstract
Purpose Demodex mites infestation, typically asymptomatic, is a problem for patients with weakened immune systems because it often takes the form of symptomatic, massive infection. The Demodex mites play an important role in the occurrence of a range of eye surface diseases such as Demodex blepharitis, Meibomian gland dysfunctions, conjunctivitis and corneal changes. The ocular infection is closely related to the systemic invasion. Our goal was to minimize infestation and alleviate the symptoms of massive demodicosis so as to prevent further damage to the cornea. Methods Our research note involves a 61-year old woman diagnosed with secondary Sjögren syndrome due to rheumatoid arthritis. On the background of the autoimmune disease, corneal perforation of the left eye occurred that was cured by surgery. Then during the follow-up visit the patient was found (microscopically) massively infected with Demodex mites and the developed symptoms were particularly severe. Results Adequate dry eye syndrome and massive demodicosis therapy significantly reduced the number of Demodex mites and improved the patient’s condition. Conclusion We would like to draw the attention of the physicians of different specialties that special care should be taken with respect to the therapy of dry eye syndrome and ocular demodicosis in patients with immunological disorders to achieve therapeutic success and avoid particularly dangerous consequences of these diseases.
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Tanabe H, Nakamura S, Kawashima M, Ishida R, Kaido M, Mizuno M, Sato EA, Inoue S, Ayaki M, Tsubota K. A Novel Lid Hygiene Detergent Successfully Eliminated Demodex Mites, a Common Pathogen of Refractory Obstructive Meibomian Gland Dysfunction. J Oleo Sci 2021; 70:799-805. [PMID: 33967173 DOI: 10.5650/jos.ess20365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Demodex mites are microscopic arthropods that have been shown to be responsible for chronic blepharitis. Although many reports have demonstrated positive effects of lid hygiene on demodicosis, some have produced conflicting results. We retrospectively evaluated the effect of lid margin cleansing with a novel lid hygiene detergent, Eye Shampoo, in patients with ocular demodicosis. METHODS Outpatient clinic notes recorded over a 24-month period between June 30, 2016, and June 29, 2018, at Keio University Hospital in Japan were reviewed to identify patients diagnosed with ocular demodicosis who started cleansing their lid margins with Eye Shampoo at least once daily as a lid hygiene therapy. RESULTS Five patients diagnosed with ocular demodicosis who started cleansing their lid margins using Eye Shampoo for lid hygiene were identified. In four cases, Demodex mites were successfully eliminated, and ocular conditions were ultimately improved with no recurrence. Active Demodex mites were still noted after 3 months of lid hygiene therapy in one case; further observation of this case was not available. There were no adverse effects of Eye Shampoo in any of these cases. CONCLUSION Lid hygiene therapy using Eye Shampoo successfully eliminated Demodex mites, a common pathogen of refractory obstructive meibomian gland dysfunction.
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Affiliation(s)
- Hirotaka Tanabe
- Department of Ophthalmology, Keio University School of Medicine.,Department of Ophthalmology, Tsukazaki Hospital
| | | | | | - Reiko Ishida
- Department of Ophthalmology, Keio University School of Medicine
| | - Minako Kaido
- Department of Ophthalmology, Keio University School of Medicine
| | - Miki Mizuno
- Department of Ophthalmology, Keio University School of Medicine
| | - Enrique A Sato
- Department of Ophthalmology, Keio University School of Medicine
| | - Sachiko Inoue
- Department of Ophthalmology, Keio University School of Medicine
| | - Masahiko Ayaki
- Department of Ophthalmology, Keio University School of Medicine
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine.,Tsubota Laboratory, Inc
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Patel NV, Mathur U, Gandhi A, Singh M. Demodex blepharokeratoconjunctivitis affecting young patients: A case series. Indian J Ophthalmol 2021; 68:745-749. [PMID: 32317439 PMCID: PMC7350462 DOI: 10.4103/ijo.ijo_1402_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To report clinical characteristics of Demodex blepharokeratoconjunctivitis affecting young patients. Methods This is a retrospective review of 14 patients with the history of chronic red eyes with corneal involvement. All patients were diagnosed with ocular demodicosis based on the results of eyelash sampling. All patients were treated with 50% tea tree oil lid scrubs and two doses of oral ivermectin (200 mcg/kg). Results The median age of patients at diagnosis was 27 years (range: 11-39 years). The duration of symptoms ranged from 2 months to 20 years. Rosacea was present in only three patients. Four patients had best corrected visual acuity less than 20/60. Allergic conjunctivitis (n = 7) and viral keratitis (n = 5) were the most common misdiagnosis previously made. Cylindrical dandruff was present in only six patients and eyelashes were clean in rest of them. Inferior vascularization was present in eight eyes, superior in seven eyes, and corneal scars were present in 12 eyes. Four patients had steroid-related complications. All patients, except one responded to tea tree oil treatment and 13 patients were off steroids after 3 weeks of starting the treatment. Conclusion Demodex infestation of eyelids can lead to chronic blepharokeratoconjunctivitis in healthy pediatric and young adult patients who otherwise have good hygiene, which can often be overlooked or misdiagnosed. Viral keratitis and allergic conjunctivitis are common misdiagnoses and demodicosis can be confirmed by simple epilation. Early diagnosis and treatment can prevent long-term steroid use and its related complications.
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Affiliation(s)
| | - Umang Mathur
- Cornea Department, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Arpan Gandhi
- Laboratory Services, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Manisha Singh
- Cornea Department, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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Martínez-Pulgarín DF, Ávila MY, Rodríguez-Morales AJ. Interventions for Demodex blepharitis and their effectiveness: A systematic review and meta-analysis. Cont Lens Anterior Eye 2021; 44:101453. [PMID: 33972176 DOI: 10.1016/j.clae.2021.101453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE A systematic review and meta-analysis was performed to evaluate the effectiveness of interventions in the treatment ofDemodex blepharitis in adult patients. METHODS A systematic review and meta-analysis of studies reporting the efficacy of treatments forDemodex blepharitis in the main databases (PubMed / Scopus / Cochrane / EMBASE / Science Direct / WOS / Scielo / Google Scholar / metaRegister of Controlled Trials / ClinicalTrials.gov/ WHO ICTRP) until November 24, 2020 was performed according to the PRISMA statement for meta-analysis. RESULTS Overall, 18 studies were included for 29 different interventions in 1195 participants with 1574 eyes that were positive for Demodex Spp. Demodex counts, total eradication, clinical improvement, Ocular Surface Disease Index, Tear Break-Up Time, cylindrical dandruff, Schirmer test, osmolarity and adverse reactions were analysed, and stratified sub-analyses conducted. The overall effects for Demodex count (mean difference), total eradication (risk ratio) and adverse reactions (risk difference) were -2.07 (95 % CI -3.99 to -0.15) p = 0.03, 1.84 (95 % CI 1.27-2.66) p = 0.001 and 0.24 (95 % CI 0.08 to 0.41) p = 0.005, respectively. The most frequent interventions evaluated in the included studies were tea tree oil (TTO) and its derivatives, such as terpinen 4-ol. CONCLUSION Multiple therapeutic choices were evaluated in this meta-analysis. Pharmacological interventions were superior to non-pharmacological (mechanical, thermal and pulsed light) interventions. It was not possible to establish significant differences between TTO and non-TTO-derived treatments. Adverse reactions were more frequent in TTO-derived treatments, however all were mild. It is necessary to execute studies with longer follow-up times to determine whether re-infestation occurs after the administration of different treatments.
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Affiliation(s)
- Dayron F Martínez-Pulgarín
- Department of Ophthalmology, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia; Basic and Clinic Ophthalmology Research Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Marcel Y Ávila
- Department of Ophthalmology, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia; Basic and Clinic Ophthalmology Research Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Alfonso J Rodríguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de las Americas, Pereira, Risaralda, Colombia
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Li J, Luo X, Liao Y, Liang L. Age differences in ocular demodicosis: Demodex profiles and clinical manifestations. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:791. [PMID: 34268404 PMCID: PMC8246181 DOI: 10.21037/atm-20-7715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/16/2021] [Indexed: 11/12/2022]
Abstract
Background Demodex infestation is highly age-dependent. Intriguingly, our previous studies that focused on children and young adult patients suggested that the clinical features of young patients were different from those studies enrolling mainly elderly patients. Whether age plays a role between young and elderly patients with ocular demodicosis remains unclear. Methods This prospective comparative study included 91 patients younger than 35 years and 92 older than 45 years with ocular demodicosis. Demodex mite count, symptoms, tear film, and ocular changes were compared between the two groups. Risk factors of meibomian gland loss (MGL) and corneal changes were analysed in the two groups. Results Demodex counts were comparable between the two groups. Young patients had higher D. brevis counts and overall percentage of D. brevis, while elderly patients had more D. folliculorum (all P<0.05). Irritation and blurred vision were more common in young patients, while eye fatigue and photophobia were more common in elderly patients (both P<0.05). The two groups had comparable tear volume and tear break-up time. Meibomian gland dysfunction was the most common sign in both groups but MGL was significantly more severe in young patients. More prevalent corneal changes and more eyelash disorders were found in young patients (both P<0.05). Female sex, a higher D. brevis percentage, lid margin anomalies, and MGL were associated with corneal change, while a higher D. brevis percentage and lid margin anomalies were related to MGL in young patients. MGL was associated with corneal change, but age was the only predictor of MGL in the elderly group. Conclusions Young patients with ocular demodicosis tend to have more D. brevis infestation, more MGL, and more corneal involvement.
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Affiliation(s)
- Jing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaohui Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yinglin Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lingyi Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Novel In-Office Technique for Visual Confirmation of Demodex Infestation in Blepharitic Patients. Cornea 2021; 39:858-861. [PMID: 32049679 DOI: 10.1097/ico.0000000000002254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine whether Demodex infestation in blepharitic patients can be confirmed by slit-lamp examination without the need for light microscopy. METHODS Demodex infestation was evaluated in 16 patients presenting with blepharitis and cylindrical dandruff at a single medical center from November 2014 to February 2015. Two lashes with cylindrical dandruff were epilated from each lid (8 per patient, total 128), mounted on slides, and examined in the clinic under a slit lamp equipped with a 90D condensing lens followed by light microscopy in the pathology laboratory. All evaluations were performed by the same pathologist. Mites were identified by their characteristic morphology and movement patterns. Findings were compared between the 2 methods. RESULTS The mean total Demodex count per lash was 1.5 ± 2.1 mites by using the slit lamp and 2 ± 2.9 mites by light microscopy. Corresponding counts per patient were 11.7 ± 9.4 and 16.1 ± 12.4. The correlation between the slit lamp and microscopy results was statistically significant, per lash (r = 0.922, P < 0.01) and per patient (r = 0.976, P < 0.01). On analysis by the more clinically relevant negative (no mites detected) or positive results (at least 1 mite detected), the accuracy of the slit-lamp examination for a single lash was 91.4% and the specificity and sensitivity were 89% and 94%, respectively; the negative predictive value was 93% [χ(1) = 87.94, P < 0.01)]. All 16 patients were positive for Demodex infestation by both methods (accuracy 100%). CONCLUSIONS Demodex infestation in blepharitic patients with cylindrical dandruff can be confirmed using only a slit lamp and common eye clinic equipment.
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Moon SY, Han SA, Kwon HJ, Park SY, Lee JH, Chung HS, Kim JY, Tchah H, Lee H. Effects of lid debris debridement combined with meibomian gland expression on the ocular surface MMP-9 levels and clinical outcomes in moderate and severe meibomian gland dysfunction. BMC Ophthalmol 2021; 21:175. [PMID: 33845799 PMCID: PMC8040198 DOI: 10.1186/s12886-021-01926-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/29/2021] [Indexed: 11/28/2022] Open
Abstract
Background To evaluate the effects of lid debris debridement and meibomian gland expression (MGX) on extracellular matrix metalloproteinase-9 (MMP-9) levels and clinical outcomes of moderate and severe MGD. Methods In this retrospective case series study, a total 48 eyes of 24 patients with moderate and severe MGD underwent one session of lid debris debridement using the BlephEx combined with MGX. We evaluated the tear film break-up time (TBUT), corneal and conjunctival fluorescein staining scores, Schirmer 1 test, biomicroscopic examination of lid margins and meibomian gland (MG), ocular surface disease index (OSDI) questionnaire score, and extracellular MMP-9 levels using a point-of-care MMP-9 immunoassay device before and 4 weeks after lid debris debridement and MGX. Linear mixed model and generalized estimating equations model were used to evaluate possible differences. Results There were significant improvements in the TBUT (P = 0.002), SICCA and Oxford staining scores (all P < 0.001), lid margin telangiectasia (P < 0.001 for upper and lower eyelids), lid thickness (P < 0.001 for upper and lower eyelids), MG orifice plugging (P < 0.001 for upper and lower eyelids), meibum color (P = 0.026 for upper eyelid, P < 0.001 for lower eyelid), meibum consistency (P < 0.001 for upper and lower eyelids), meibum grade (P < 0.001), MGD stage (P < 0.001), and OSDI score (P = 0.002). MMP-9 immunoassay positivity rate significantly decreased from 83.3 to 50.0% 4 weeks after treatment (P = 0.014). Conclusions In patients with moderate to severe MGD, lid debris debridement using the BlephEx combined with MGX improved clinical findings, subjective symptoms, meibomian gland function, along with ocular surface MMP-9 level. We hereby suggest lid debris debridement using BlephEx combined with MGX as an effective clinical strategy for treatment of moderate to severe MGD.
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Affiliation(s)
- Su Young Moon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Sol Ah Han
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hye Ji Kwon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - So Young Park
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jae Hyuck Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Ho Seok Chung
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hungwon Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea.
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Liu W, Gong L. Anti-demodectic effects of okra eyelid patch in Demodex blepharitis compared with tea tree oil. Exp Ther Med 2021; 21:338. [PMID: 33732311 PMCID: PMC7903416 DOI: 10.3892/etm.2021.9769] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/18/2021] [Indexed: 02/07/2023] Open
Abstract
Demodex infection gradually develops to Demodex blepharitis, which is characterized as chronic inflammation of the eyelid and meibomian gland (MG) and ultimately leads to MG dysfunction. In the present prospective study, the anti-demodectic effects of an okra eyelid patch in patients Demodex blepharitis were investigated. A total of 52 patients with Demodex blepharitis with ocular discomfort were recruited. Patients were randomized to receive either an okra eyelid patch treatment (treatment group, n=27) or tea tree oil (TTO) eye care patch treatment (control group, n=25) for three months. The Demodex count, the ocular surface disease index (OSDI) score, MG expressibility (MGE) and meibum quality, Schirmer I test (SIT), tear break-up time (TBUT) and corneal fluorescein staining (CFS) were determined prior to treatment and after 1 and 3 months of treatment. Changes in the parameters were compared between the treatment group and control group after 1 and 3 months of treatment. The average survival time in the okra group was 115.25±11.87 min, which was significantly lower compared with the average ST of 378.75±37.94 min in the blank group (P<0.01). After 3 months of okra eyelid patch treatment, the Demodex count was significantly reduced from 10.15±4.53 to 1.30±1.41 (P<0.01) and the OSDI score of the patients was reduced by 16.84±10.17 (P<0.01). There was no significant difference in the Demodex count (P=0.716) and OSDI (P=0.873) between the treatment and control groups. The rate of complete Demodex eradication in the treatment group (11/27, 40.74%) was slightly lower than that in the control group (12/25, 48%), but there was no significant difference between the two groups (χ2=0.277, P=0.598). Regarding the other ocular parameters, no significant difference was observed in the TBUT, meibum quality and MGE between the two groups (P<0.05). TTO group has a significantly improvement compared with Okra group in terms of SIT (P=0.035) and CFS (P=0.023). In conclusion, okra eyelid patch treatment is able to significantly eradicate ocular Demodex as well as markedly alleviate ocular symptoms. Due to causing less irritation than TTO, the okra eyelid patch may be more suitable for sensitive patients with Demodex blepharitis, such as the elderly and children. The study was registered as a clinical trial in the Chinese Clinical Trial Registry (ChiCTR) in November 2018 (registration no. ChiCTR-1,800,019,466).
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Affiliation(s)
- Wenting Liu
- Department of Ophthalmology and Vision Science, The Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, P.R. China
- NHC Key Laboratory of Myopia, Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai 200031, P.R. China
| | - Lan Gong
- Department of Ophthalmology and Vision Science, The Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, P.R. China
- NHC Key Laboratory of Myopia, Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai 200031, P.R. China
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Tavassoli S, Wong N, Chan E. Ocular manifestations of rosacea: A clinical review. Clin Exp Ophthalmol 2021; 49:104-117. [PMID: 33403718 DOI: 10.1111/ceo.13900] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/07/2020] [Accepted: 12/18/2020] [Indexed: 12/13/2022]
Abstract
Ocular rosacea is a chronic inflammatory condition that can occur in the absence of cutaneous features. The most common ocular features are chronic blepharoconjunctivitis with eyelid margin inflammation and meibomian gland dysfunction. Corneal complications include corneal vascularization, ulceration, scarring and, rarely, perforation. Diagnosis is largely based on clinical signs, although it is often delayed in the absence of cutaneous changes, particularly in children. It can also be associated with systemic disorders such as cardiovascular disease. Management ranges from local therapy to systemic treatment, depending on the severity of the disease. In this review, we describe the epidemiology, pathophysiology, clinical features and treatment of rosacea and ocular rosacea.
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Affiliation(s)
| | - Nathan Wong
- Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Elsie Chan
- Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
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Nowomiejska K, Lukasik P, Brzozowska A, Toro MD, Sedzikowska A, Bartosik K, Rejdak R. Prevalence of Ocular Demodicosis and Ocular Surface Conditions in Patients Selected for Cataract Surgery. J Clin Med 2020; 9:jcm9103069. [PMID: 32977656 PMCID: PMC7598293 DOI: 10.3390/jcm9103069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/06/2020] [Accepted: 09/21/2020] [Indexed: 12/23/2022] Open
Abstract
The aim of the study was to analyze the prevalence of ocular demodicosis and ocular surface conditions in patients selected for cataract surgery. Eyelashes from 73 patients selected for cataract surgery were evaluated at × 40 and × 100 magnification using light microscopy. The anterior segment was assessed with the slit lamp. Additionally, Schirmer I and break up time (BUT) tests were carried out before surgery and 1 and 3 months postoperatively. A specially designed questionnaire containing e.g. information about chronic skin and eye diseases, previous ophthalmic surgeries, and patient's hygiene habits was used to assess the demographic variables. A majority of patients were at the age of 70-79 years, and there were more females (83%) in the study group. Demodex folliculorum was found in 48% of the patients. There was a correlation between the number of parasites and the presence of blepharitis, discharge at eyelid margins, and conjunctival hyperemia. Schirmer I and BUT test results were lower in patients with Demodex infestation before and after cataract surgery. The higher number of mites was correlated with lower Schirmer I test results postoperatively. The presence of Demodex mites influences the conjunctiva and lid margins leading to inflammation. The higher number of Demodex mites disturbs the tear film over time after cataract surgery.
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Affiliation(s)
- Katarzyna Nowomiejska
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (P.L.); (M.D.T.); (R.R.)
- Correspondence:
| | - Piotr Lukasik
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (P.L.); (M.D.T.); (R.R.)
- Department of Ophthalmology, John Paul II Public Hospital in Zamosc, 22-400 Zamosc, Poland
| | - Agnieszka Brzozowska
- Department of Mathematics and Medical Biostatistics, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Mario Damiano Toro
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (P.L.); (M.D.T.); (R.R.)
- Faculty of Medicine, Collegium Medicum Cardinal Stefan Wyszynski University, 01-815 Warsaw, Poland
| | - Aleksandra Sedzikowska
- Department of General Biology and Parasitology, Medical University of Warsaw, 02-004 Warsaw, Poland;
| | - Katarzyna Bartosik
- Chair and Department of Biology and Parasitology, Medical University of Lublin, 20-080 Lublin, Poland;
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (P.L.); (M.D.T.); (R.R.)
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Starr CE, Gupta PK, Farid M, Beckman KA, Chan CC, Yeu E, Gomes JAP, Ayers BD, Berdahl JP, Holland EJ, Kim T, Mah FS. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg 2020; 45:669-684. [PMID: 31030780 DOI: 10.1016/j.jcrs.2019.03.023] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 12/28/2022]
Abstract
Any ocular surface disease (OSD), but most commonly, dry-eye disease (DED), can reduce visual quality and quantity and adversely affect refractive measurements before keratorefractive and phacorefractive surgeries. In addition, ocular surgery can exacerbate or induce OSD, leading to worsened vision, increased symptoms, and overall dissatisfaction postoperatively. Although most respondents of the recent annual American Society of Cataract and Refractive Surgery (ASCRS) Clinical Survey recognized the importance of DED on surgical outcomes, many were unaware of the current guidelines and most were not using modern diagnostic tests and advanced treatments. To address these educational gaps, the ASCRS Cornea Clinical Committee developed a new consensus-based practical diagnostic OSD algorithm to aid surgeons in efficiently diagnosing and treating visually significant OSD before any form of refractive surgery is performed. By treating OSD preoperatively, postoperative visual outcomes and patient satisfaction can be significantly improved.
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Affiliation(s)
- Christopher E Starr
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA.
| | | | - Marjan Farid
- Gavin Herbert Eye Institute, University of California, Irvine, California, USA
| | - Kenneth A Beckman
- Department of Ophthalmology, The Ohio State University and Comprehensive EyeCare of Central Ohio, Westerville, Ohio, USA
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada
| | - Elizabeth Yeu
- Eastern Virginia Medical School, Virginia Eye Consultants, Norfolk, Virginia, USA
| | - José A P Gomes
- Paulista Medical School, Federal University of São Paulo, Brazil
| | | | | | | | - Terry Kim
- Duke University Eye Center, Durham, North Carolina, USA
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Abstract
Demodex is the most common parasite living on humans and yet little is understood about its pathogenicity with respect to the ocular surface. An increasing interest in Demodex over the past 20-years has increased our understanding of this mite and its pathogenetic role. This article begins with a review of the anatomy, life cycle, mode of transmission and advances in genetics that can distinguish between Demodex folliculorum and Demodex brevis, the only two Demodex species in humans. Additionally, a review of diagnostic procedures and existing and emerging ocular and systemic management options are presented. Despite the increasing interest in Demodex in the literature, there remains numerous obstacles for future studies, hence a section of this review is dedicated to the identification and proposal for future considerations. The lack of uniformity with respect to terminology, diagnostic technique and management approach for Demodex remain as obstacles for future study comparisons. This review summarised the current knowledge on Demodex and hopes to offer some recommendations for future directions in the study of Demodex in humans.
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Affiliation(s)
- Etty Bitton
- École d'optométrie, Université de Montréal, Montreal, Québec, Canada
| | - Sarah Aumond
- École d'optométrie, Université de Montréal, Montreal, Québec, Canada
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The Effect of Ocular Demodex Colonization on Schirmer test and OSDI Scores in Newly Diagnosed Dry Eye Patients. Eye Contact Lens 2020; 46 Suppl 1:S39-S41. [PMID: 31393313 DOI: 10.1097/icl.0000000000000640] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether ocular Demodex colonization results in differences in Schirmer test scores and Ocular Surface Disease Index (OSDI) questionnaire values in individuals with dry eye disease (DED) diagnosed for the first time. METHOD Eighty-eight adults aged 40 to 68 years who were admitted to Ophthalmology outpatient clinic for routine ophthalmological examination or presbyopia examination and diagnosed with DED for the first time and who do not have any chronic disease were included in the study. All the patients were asked to complete the OSDI, which is widely used for assessing dry eye symptom severity and vision-related functioning. The Schirmer test was performed, and then two eyelashes were taken from the inferior eyelids of each eyes. After saline (0.09% NaCl) was added to the sample, it was quickly taken to the microbiology laboratory, which is located next to the Ophthalmology policlinic. The sample was evaluated by a parasitologist experienced in Demodex. RESULTS One hundred sixty-eight eyes of 84 patients were included in the study. Average Schirmer test score was 2.1±0.5, the OSDI questionnaire score was 61.82±10.95, and the mean age was 55.36±8.74 years in patients who had Demodex colonization (n=30), whereas the average Schirmer test score was 6.6±0.9 score, OSDI questionnaire score was 40.96±12.73, and the mean age was 49.12±6.87 years in patients without Demodex colonization (n=58). It has been observed that dry eye patients with Demodex colonization had a higher mean age (P: 0.001), higher mean OSDI score (P: 0.001), and lower average Schirmer test score (P: 0.001) compared with those without Demodex. The significant relationship between lower Schirmer test score and higher OSDI rates and occurrence of Demodex infestation continued after adjusting for mean age values (P=0.012; P=0.035). CONCLUSION It was determined that the presence of ocular Demodex colonization was associated with the average Schirmer test scores, OSDI scores, and age values in patients with newly diagnosed DED. Demodex quantity was found increased in older aged patients, but the significant relationship between lower Schirmer test score and higher OSDI rates and Demodex infestation persisted even after controlling the mean age values. Supporting these findings with large-numbered and randomized-controlled studies will help in clarifying the association of the Demodex infestation with etiopathogenesis of dry eye.
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Comparison of Biomicroscopy and Light Microscopy Findings in Demodex Diagnosis in Patients With Chronic Blepharitis. Eye Contact Lens 2020; 46:297-300. [DOI: 10.1097/icl.0000000000000660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Demodex-Mite Infestation in Cilia and its Association With Ocular Surface Parameters in Japanese Volunteers. Eye Contact Lens 2020; 46:291-296. [DOI: 10.1097/icl.0000000000000656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Gostimir M, Allen LH. Is there enough evidence for the routine recommendation of eyelid wipes? A systematic review of the role of eyelid wipes in the management of blepharitis. Can J Ophthalmol 2020; 55:424-436. [PMID: 32835674 DOI: 10.1016/j.jcjo.2020.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/15/2020] [Accepted: 05/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Eyelid wipes are routinely recommended for blepharitis, but these do not come without financial cost and potential adverse effects. This review aimed to provide a comprehensive summary of existing evidence for the efficacy and safety of eyelid wipes in the management of blepharitis. METHODS A search of Medline and Embase was conducted to identify studies that assessed the efficacy of an eyelid wipe option. Studies that included other interventions were excluded, as well as studies that evaluated warm compresses. Risk of bias, adverse effects, cost, and availability assessments were also performed. RESULTS After the review of 1650 search results, 16 studies were included. A variety of eyelid wipes were studied, including common household products, tea tree oil-based products, commercial solutions, and commercial wipes. Some efficacy was demonstrated for all options that were studied, and most improvements were noted within 1 or 2 months. There was not enough evidence to determine the relative efficacy of different options. There was significant heterogeneity, and all nongeneric options were limited to 1 study, which precluded meta-analysis. The risk of bias assessment revealed concerns regarding the quality of evidence, and notably, several studies were supported by the manufacturing company. CONCLUSIONS Although some efficacy has been demonstrated for several types of eyelid wipes, including common household products, there remains a lack of robust evidence to support their routine recommendation. Long-term costs and potential adverse effects should not be overlooked. There is not enough evidence to suggest superiority of one option over others.
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Affiliation(s)
| | - Larry H Allen
- Ivey Eye Institute, Western University, London, Ont..
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Comparison of the efficacy of tea tree ( Melaleuca alternifolia) oil with other current pharmacological management in human demodicosis: A Systematic Review. Parasitology 2020; 147:1587-1613. [PMID: 32772960 DOI: 10.1017/s003118202000150x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Various treatments are found to be moderately effective in managing Demodex-related diseases except tea tree oil (TTO) and terpinen-4-ol (T4O), which showed superior miticidal and anti-inflammatory effects in numerous clinical studies. Their possible effects include lowering mite counts, relieving Demodex-related symptoms, and modulating the immune system. This review summarizes the current clinical topical and oral treatments in human demodicosis, their possible mechanisms of action, side-effects and resistance in treating this condition. TTO (especially T4O) is found to be the most effective followed by metronidazole, ivermectin and permethrin in managing the disease. This is because TTO has anti-parasitic, anti-bacterial, anti-fungal, anti-inflammatory and wound-healing effects. Furthermore, nanoTTO can even release its contents into fungus and Pseudomonas biofilms. Combinations of different treatments are occasionally needed for refractory cases, especially for individuals with underlying genetic predisposal or are immuno-compromised. Although the current treatments show efficacy in controlling the Demodex mite population and the related symptoms, further research needs to be focused on the efficacy and drug delivery technology in order to develop alternative treatments with better side-effects profiles, less toxicity, lower risk of resistance and are more cost-effective.
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Zhang AC, Muntz A, Wang MTM, Craig JP, Downie LE. Ocular Demodex: a systematic review of the clinical literature. Ophthalmic Physiol Opt 2020; 40:389-432. [PMID: 32691894 DOI: 10.1111/opo.12691] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/06/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE There is increasing clinical and research interest in the potential contribution of Demodex to ocular surface disease. The aim of this systematic review was to summarise and synthesise current clinical evidence relating to the aetiology, diagnosis and treatment of ocular Demodex. RECENT FINDINGS A comprehensive literature search was performed in OVID Medline, OVID Embase, and clinical trial registries, for studies published between 1990 and August 2019, examining Demodex on the ocular surface. The review included primary clinical research studies and systematic reviews of primary clinical research studies, where Demodex was considered in the context of the ocular surface and/or adnexa. Studies were categorised using the National Health and Medical Research Council evidence hierarchy. Risk of bias assessment was performed using validated tools for studies categorised as providing Level I or II evidence. A total of 87 studies were eligible for inclusion, including two systematic reviews. Most studies (60%) were observational, describing the prevalence of ocular Demodex in different clinical populations. There was a high degree of variability in the epidemiological data derived from cross-sectional aetiology studies. There was mostly consistent evidence to support an association between ocular Demodex and chronic blepharitis. Seven diagnostic test-accuracy studies were identified, which considered a range of techniques, including slit lamp examination for cylindrical eyelash collarettes and/or eyelash manipulation techniques, light microscopic evaluation of epilated eyelashes and in vivo confocal microscopy. There is currently no accepted gold-standard diagnostic method for ocular Demodex. For intervention studies, there was one systematic review, 11 published randomised trials, six trial registry entries, and nine case series. Despite a number of recent trials, the appropriate treatment regimen for ocular Demodex (including the optimal criteria and timing of an intervention) is not clearly established. CONCLUSIONS This comprehensive narrative synthesis has captured the landscape of clinical evidence relating to the prevalence, aetiology, diagnosis and treatment of ocular Demodex. There remain opportunities to enhance understanding of its role in ocular surface disease, best diagnostic approaches and optimal treatment protocols.
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Affiliation(s)
- Alexis Ceecee Zhang
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Alex Muntz
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
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Jabbehdari S, Memar OM, Caughlin B, Djalilian AR. Update on the pathogenesis and management of ocular rosacea: an interdisciplinary review. Eur J Ophthalmol 2020; 31:22-33. [PMID: 32586107 DOI: 10.1177/1120672120937252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Rosacea is one of the most common conditions affecting the ocular surface. The purpose of this review is to provide an update on the pathogenesis and treatment of rosacea based on the dermatology and ophthalmology literatures. METHODS Literature searches were conducted for rosacea and ocular rosacea. Preference was given to systematic reviews, meta-analysis, case-controlled studies, and documented case reports while excluding poorly documented case studies and commentaries. The data were examined and independently analyzed by more than two of the authors. RESULTS Rosacea is a complex inflammatory condition involving the pilosebaceous unit. Its underlying mechanism involves an interplay of the microbiome, innate immunity, adaptive immunity, environmental triggers, and neurovascular sensitivity. The latest classification of rosacea includes three dermatologic subgroups and a fourth subgroup, ocular rosacea. Ocular rosacea clinically displays many features that are analogous to the cutaneous disease, such as lid margin telangiectasia and phlyctenulosis. The role of environmental triggers in the exacerbation of ocular rosacea appears to be understudied. While lid hygiene and systemic treatment with tetracycline drugs remain the mainstay of treatment for ocular rosacea, newer dermatologic targets and therapies may have potential application for the eye disease. CONCLUSIONS Ocular rosacea appears to embody many of the manifestation of the dermatologic disease. Hence, the basic pathophysiologic mechanisms of the ocular and cutaneous disease are likely to be shared. Better understanding of the ocular surface microbiome and the immunologic mechanisms, may lead to novel approaches in the management of ocular rosacea.
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Affiliation(s)
- Sayena Jabbehdari
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Benjamin Caughlin
- Department of Surgery/Division of Otolaryngology, Jr. Hospital of Cook County, Chicago, IL, USA.,Hospital of Cook County, Chicago, IL, USA.,Division of Facial Plastic and Reconstructive Surgery, Jesse Brown VA Medical Center, Chicago, IL, USA.,Division of Facial Plastic and Reconstructive Surgery, University of Illinois Health Hospital System, Chicago, IL, USA
| | - Ali R Djalilian
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA
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Abstract
BACKGROUND Demodex blepharitis is a chronic condition commonly associated with recalcitrant dry eye symptoms though many people with Demodex mites are asymptomatic. The primary cause of this condition in humans is two types of Demodex mites: Demodex folliculorum and Demodex brevis. There are varying reports of the prevalence of Demodex blepharitis among adults, and it affects both men and women equally. While Demodex mites are commonly treated with tea tree oil, the effectiveness of tea tree oil for treating Demodex blepharitis is not well documented. OBJECTIVES To evaluate the effects of tea tree oil on ocular Demodex infestation in people with Demodex blepharitis. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 6); Ovid MEDLINE; Embase.com; PubMed; LILACS; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We used no date or language restrictions in the electronic search for trials. We last searched the databases on 18 June 2019. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared treatment with tea tree oil (or its components) versus another treatment or no treatment for people with Demodex blepharitis. DATA COLLECTION AND ANALYSIS Two review authors independently screened the titles and abstracts and then full text of records to determine their eligibility. The review authors independently extracted data and assessed risk of bias using Covidence. A third review author resolved any conflicts at all stages. MAIN RESULTS We included six RCTs (1124 eyes of 562 participants; 17 to 281 participants per study) from the US, Korea, China, Australia, Ireland, and Turkey. The RCTs compared some formulation of tea tree oil to another treatment or no treatment. Included participants were both men and women, ranging from 39 to 55 years of age. All RCTs were assessed at unclear or high risk of bias in one or more domains. We also identified two RCTs that are ongoing or awaiting publications. Data from three RCTs that reported a short-term mean change in the number of Demodex mites per eight eyelashes contributed to a meta-analysis. We are uncertain about the mean reduction for the groups that received the tea tree oil intervention (mean difference [MD] 0.70, 95% confidence interval [CI] 0.24 to 1.16) at four to six weeks as compared to other interventions. Only one RCT reported data for long-term changes, which found that the group that received intense pulse light as the treatment had complete eradication of Demodex mites at three months. We graded the certainty of the evidence for this outcome as very low. Three RCTs reported no evidence of a difference for participant reported symptoms measured on the Ocular Surface Disease Index (OSDI) between the tea tree oil group and the group receiving other forms of intervention. Mean differences in these studies ranged from -10.54 (95% CI - 24.19, 3.11) to 3.40 (95% CI -0.70 7.50). We did not conduct a meta-analysis for this outcome given substantial statistical heterogeneity and graded the certainty of the evidence as low. One RCT provided information concerning visual acuity but did not provide sufficient data for between-group comparisons. The authors noted that mean habitual LogMAR visual acuity for all study participants improved post-treatment (mean LogMAR 1.16, standard deviation 0.26 at 4 weeks). We graded the certainty of evidence for this outcome as low. No RCTs provided data on mean change in number of cylindrical dandruff or the proportion of participants experiencing conjunctival injection or experiencing meibomian gland dysfunction. Three RCTs provided information on adverse events. One reported no adverse events. The other two described a total of six participants randomized to treatment with tea tree oil who experienced ocular irritation or discomfort that resolved with re-educating the patient on application techniques and continuing use of the tea tree oil. We graded the certainty of the evidence for this outcome as very low. AUTHORS' CONCLUSIONS The current review suggests that there is uncertainty related to the effectiveness of 5% to 50% tea tree oil for the short-term treatment of Demodex blepharitis; however, if used, lower concentrations may be preferable in the eye care arena to avoid induced ocular irritation. Future studies should be better controlled, assess outcomes at long term (e.g. 10 to 12 weeks or beyond), account for patient compliance, and study the effects of different tea tree oil concentrations.
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Affiliation(s)
- Keyur Savla
- School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jimmy T Le
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew D Pucker
- School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, USA
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M H S, A R S. Role of demodex infestation in blepharitis and coconut oil as a treatment option. ACTA ACUST UNITED AC 2020. [DOI: 10.18231/j.ijceo.2020.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To assess incidence of demodex species, correlate ocular symptomatology, evaluate efficacy of coconut oil as treatment method in all types of blepharitis. 30 patients with anterior & mixed blepharitis, meibomian gland dysfunction & non-specific irritation were enrolled for study. History taken & examined clinically. 2 lashes/lid were sampled & mounted on slides with normal saline & observed under light microscope. Number of mites counted. Patients positive for demodex were treated with coconut oil application over lid margins & reviewed after 3 weeks. Incidence of demodex was 40% & it increased with age. Demodex was commonly associated with meibomian gland dysfunction, non-specific irritation, madarosis, cloudy & toothpaste like meibum quality. Burning sensation and itching were common complaints. At 3rd week, all patients were symptom-free. Mite count dropped by 52.8% but were not eliminated. Demodex infestation is often overlooked but it is associated with about half of blepharitis cases. Hence further evaluation should be considered. Coconut oil is an easily available mode of treatment & helps reduce symptoms and mite counts.
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50
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Palpebral and facial skin infestation by Demodex folliculorum. Cont Lens Anterior Eye 2020; 43:115-122. [DOI: 10.1016/j.clae.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022]
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