Original article
Corneal Manifestations of Ocular Demodex Infestation

https://doi.org/10.1016/j.ajo.2007.01.054Get rights and content

Purpose

To report the corneal manifestations in eyes with Demodex infestation of the eyelids.

Design

Noncomparative, interventional case series.

Methods

This retrospective review included six patients with Demodex blepharitis who also exhibited corneal abnormalities, which led to suspicion of limbal stem cell deficiency in three cases. All patients received weekly lid scrubs with 50% tea tree oil and a daily lid scrubs with tea tree shampoo for a minimum of six weeks. Improvement of symptoms and corneal and conjunctival signs were evaluated.

Results

All six patients exhibited ocular irritation and conjunctival inflammation, while meibomian gland dysfunction (n = 5), rosacea (n = 4), and decreased vision (n = 3) also were noted despite prior treatments with oral tetracycline, topical steroids with antibiotics, and lid scrub with baby shampoo. These patients were proven to have Demodex folliculorum (n = 6) and Demodex brevis (n = 3) by microscopic examination of epilated lashes. Their corneal manifestation included superficial corneal vascularization (six eyes of five cases), marginal corneal infiltration (two eyes of two cases), phlyctenule-like lesion (one eye of one case), superficial corneal opacity (two eyes of two cases), and nodular corneal scar (two eyes of two cases). After treatment, the Demodex count was reduced from 6.8 ± 2.8 to 1 ± 0.9 (standard deviation; P = .001). All patients showed dramatic resolution of ocular irritation, conjunctival inflammation, and all inflammatory, but not scarred, corneal signs; three patients showed improved vision.

Conclusions

A variety of corneal pathologic features together with conjunctival inflammation, commonly noted in rosacea, can be found in patients with Demodex infestation of the eyelids. When conventional treatments for rosacea fail, one may consider lid scrub with tea tree oil to eradicate mites as a new treatment.

Section snippets

Methods

This study was conducted at the Ocular Surface Center, Miami, Florida, and was approved by the Institutional Review Board of Baptist Hospital of Miami/South Miami Hospital, Inc, Miami, Florida, to review retrospectively the medical records of six patients proven to have ocular demodicosis while also demonstrating abnormal corneal findings at presentation. All of them had either diffuse or sporadic cylindrical dandruff at presentation, defined as scales formed as distinct cuffs, collaring the

Results

These six patients included two women and four men, with an average age of 49.3 ± 17 years (standard deviation; range, 30 to 70 years). Demographic and other clinical features are summarized in the Table. All of them reported ocular surface irritation lasting several years. Their symptoms included redness (n = 5), blurred vision (n = 3), misdirected lashes (n = 2), vague ocular irritation (n = 1), ocular pain (n = 1), and recurrent chalazia (n = 1). Their symptoms persisted despite prior

Discussion

Demodex infestation in the facial skin has been implicated in causing rosacea1, 5, 6, 15, 16 and in the eyelid in giving rise to blepharitis.7, 8, 9, 10 Recently, we provided strong evidence supporting the notion that such blepharitis frequently is associated with mite-harboring cylindrical dandruff in eyelashes.12 Furthermore, we reported that 11 eyes with Demodex infestation in eyelashes also manifested trichiasis, meibomian gland dysfunction with lipid tear deficiency, and conjunctival

Scheffer C. G. Tseng, MD, PhD, after completing a residency at Johns Hopkins Hospital in 1984 and a cornea fellowship at Massachusetts Eye & Ear Infirmary in 1986, Dr Tseng had become a chaired professor at Bascom Palmer Eye Institute until 2002, when he assumed the medical director of Ocular Surface Center and Ocular Surface Research & Education Foundation, and R&D Director of TissueTech, Inc. Dr Tseng has been devoted to bridging clinical and basic research in ocular surface diseases and

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  • Cited by (0)

    Scheffer C. G. Tseng, MD, PhD, after completing a residency at Johns Hopkins Hospital in 1984 and a cornea fellowship at Massachusetts Eye & Ear Infirmary in 1986, Dr Tseng had become a chaired professor at Bascom Palmer Eye Institute until 2002, when he assumed the medical director of Ocular Surface Center and Ocular Surface Research & Education Foundation, and R&D Director of TissueTech, Inc. Dr Tseng has been devoted to bridging clinical and basic research in ocular surface diseases and reconstruction.

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