Elsevier

Ophthalmology

Volume 117, Issue 5, May 2010, Pages 870-877.e1
Ophthalmology

Original article
Correlation between Ocular Demodex Infestation and Serum Immunoreactivity to Bacillus Proteins in Patients with Facial Rosacea

https://doi.org/10.1016/j.ophtha.2009.09.057Get rights and content

Purpose

To investigate correlation between ocular Demodex infestation and serum.

Design

A prospective study to correlate clinical findings with laboratory data.

Participants

We consecutively enrolled 59 patients: 34 men and 25 women with a mean age of 60.4±17.6 years (range, 17–93).

Methods

Demodex counting was performed based on lash sampling. Serum immunoreactivity to two 62-kDa and 83-kDa proteins derived from B oleronius was determined by Western blot analysis. Facial rosacea, lid margin, and ocular surface inflammation were documented by photography and graded in a masked fashion.

Main Outcome Measures

Statistical significance based on correlative analyses of clinical and laboratory data.

Results

These 59 patients were age matched, but not gender matched, regarding serum immunoreactivity, ocular Demodex infestation, or facial rosacea. There was a significant correlation between serum immunoreactivity and facial rosacea (P = 0.009), lid margin inflammation (P = 0.040), and ocular Demodex infestation (P = 0.048), but not inferior bulbar conjunctival inflammation (P = 0.573). The Demodex count was significantly higher in patients with positive facial rosacea (6.6±9.0 vs. 1.9±2.2; P = 0.014). There was a significant correlation of facial rosacea with lid margin inflammation (P = 0.016), but not with inferior bulbar conjunctival inflammation (P = 0.728). Ocular Demodex infestation was less prevalent in patients with aqueous tear-deficiency dry eye than those without (7/38 vs. 12/21; P = 0.002).

Conclusions

The strong correlation provides a better understanding of comorbidity between Demodex mites and their symbiotic B oleronius in facial rosacea and blepharitis. Treatments directed to both warrant future investigation.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Patients

This study followed the tenets of the Helsinki Declaration of Human Studies and has been approved by the ethics committee of the Ocular Surface Research and Education Foundation. A total of 59 patients who presented with a number of ocular surface diseases (Table 1; available online at http://aaojournal.org) were consecutively enrolled in the Ocular Surface Center (Miami, FL) from September 2008 to April 2009. For all patients, in addition to routine complete eye examinations, photographs were

Results

The 59 patients consisted of 34 men and 25 women with a mean age of 60.4±17.6 years (range, 17–93). Their age distribution was not different when they were subdivided into 2 groups according to the presence or absence of serum immunoreactivity, ocular Demodex infestation, facial rosacea, or aqueous tear-deficiency dry eye (P = 0.151, 0.805, 0.868, and 0.706, respectively; Table 2). When the Demodex counts were analyzed, we did not note any significant correlation in the age distribution

Discussion

Lacey et al23 first linked skin mite infestation and microbial infection to explain why cutaneous inflammation occurs in facial rosacea. Specifically, their experimental evidence supports the notion that cutaneous inflammation might be exacerbated by strong host immune responses to proteins produced by B oleronius living inside Demodex mites. Herein, our collaborative study further established the comorbidity between Demodex infestation and Bacillus infection in facial rosacea. This finding

References (28)

  • Y.Y. Gao et al.

    High prevalence of Demodex in eyelashes with cylindrical dandruff

    Invest Ophthalmol Vis Sci

    (2005)
  • A. Kheirkhah et al.

    Fluorescein dye improves microscopic evaluation and counting of Demodex in blepharitis with cylindrical dandruff

    Cornea

    (2007)
  • Y.Y. Gao et al.

    In vitro and in vivo killing of ocular Demodex by tea tree oil

    Br J Ophthalmol

    (2005)
  • Y.Y. Gao et al.

    Clinical treatment of ocular demodecosis by lid scrub with tea tree oil

    Cornea

    (2007)
  • Cited by (110)

    • Successful management of chronic Blepharo-rosacea associated demodex by lid scrub with terpinen-4-ol

      2021, American Journal of Ophthalmology Case Reports
      Citation Excerpt :

      In addition, demodex complicates the clinical course and was found more prevalent in patients with chronic severe rosacea compared to rosacea without demodex involvement.3 These mites may link to the chronicity of disease by stimulating the inflammatory process which subsequently leads to tissue damage and aggravation of telangiectasias.1,4 Previously, it was reported eyelid scrubs with tea tree oil (TTO) are effective in reducing demodex counts and ocular surface inflammation.

    • Microbiome: Role in Inflammatory Skin Diseases

      2024, Journal of Inflammation Research
    View all citing articles on Scopus

    Manuscript no. 2009-896.

    NOR is the recipient of a Hume Scholarship.

    Financial Disclosure(s): The authors have made the following disclosures: Scheffer C. G. Tseng has filed 2 patents for the use of tea tree oil and its ingredients for treating demodicosis.

    View full text