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Page MR. Multidisciplinary perspectives in Demodex blepharitis: A new view of treatment from clinical, payer, and patient perspectives. J Manag Care Spec Pharm 2024; 30:S1-S8. [PMID: 39222399 PMCID: PMC11368203 DOI: 10.18553/jmcp.2024.30.10-a.s1] [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: 09/04/2024]
Abstract
Demodex infestation is the cause of more than two-thirds of all cases of blepharitis in the United States. Although symptoms may include crustiness, redness, or itching of the eyelids, diagnosis can be accomplished through a simple examination of the eyelashes. The presence of a waste product of the Demodex mite, known as collarettes, on the base of the eyelashes is a pathognomonic sign of Demodex blepharitis. Demodex infestation that results in blepharitis may cause blockage and ultimately atrophy of the meibomian glands, worsening dry eye disease. Until recently, management of Demodex blepharitis has been limited by a lack of approved therapy options. Lotilaner ophthalmic solution 0.25%, the first approved therapy for treatment of Demodex blepharitis, has not only been shown to eradicate Demodex mites in one-half to two-thirds of patients following short-term treatment but also demonstrated continued benefits through 1 year of follow-up. In addition to managing Demodex blepharitis, treatment with lotilaner ophthalmic solution 0.25% may aid in the management of dry eye disease and other forms of ocular surface disease caused by complications of Demodex infestation. As a result, it is possible that successful management of Demodex blepharitis may reduce chronic use of health care resources dedicated to managing other chronic ocular conditions. As eye care professionals recognize Demodex infestation as a key mediator of ocular surface disease, increasing diagnostic awareness and addressing this underlying cause of Demodex blepharitis may reduce the need for specialist follow-up care, decrease the need for chronic therapy, and improve patient outcomes. Through routine screening for Demodex infestation and Demodex blepharitis, eye care professionals can now address an underlying factor in ocular surface disease to improve use of health care resources in the community.
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Gupta PK, Toyos R, Sheppard JD, Toyos M, Mah FS, Bird B, Theriot PE, Higgins D. Tolerability of Current Treatments for Dry Eye Disease: A Review of Approved and Investigational Therapies. Clin Ophthalmol 2024; 18:2283-2302. [PMID: 39165367 PMCID: PMC11334916 DOI: 10.2147/opth.s465143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/06/2024] [Indexed: 08/22/2024] Open
Abstract
Dry eye disease (DED) is a common, multifactorial ocular disease impacting 5% to 20% of people in Western countries and 45% to 70% in Asian countries. Despite the prevalence of DED and the number of treatment approaches available, signs and symptoms of the disease continue to limit the quality of life for many patients. Standard over-the-counter treatment approaches and behavior/environmental modifications may help some cases but more persistent forms often require pharmacological interventions. Approved and investigational pharmaceutical approaches attempt to treat the signs and symptoms of DED in different ways and tend to have varying tolerability among patients. While several pharmacological approaches are the standard for persistent and severe disease, mechanical options provide alternate treatment modalities that attempt to balance efficacy and comfort. Newer approaches target the causes of DED, utilizing novel delivery methods to minimize irritation and adverse events. Here, we review approved and investigational approaches to treating DED and compare patient tolerability.
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Affiliation(s)
- Preeya K Gupta
- Triangle Eye Consultants, Raleigh, NC, USA
- Department of Ophthalmology, Tulane University, New Orleans, LA, USA
| | | | | | | | | | - Brian Bird
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Don Higgins
- Dry Eye Treatment Center of Connecticut, Plainville, CT, USA
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Rocha KM, Farid M, Raju L, Beckman K, Ayres BD, Yeu E, Rao N, Chamberlain W, Zavodni Z, Lee B, Schallhorn J, Garg S, Mah FS. Eyelid margin disease (blepharitis and meibomian gland dysfunction): clinical review of evidence-based and emerging treatments. J Cataract Refract Surg 2024; 50:876-882. [PMID: 38350160 DOI: 10.1097/j.jcrs.0000000000001414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/27/2024] [Indexed: 02/15/2024]
Abstract
Blepharitis is a common ophthalmic condition with multiple etiologies and no definitive, universal treatment. The treatment modalities for managing lid margin diseases vary depending on the disease's cause, location, and severity. For anterior blepharitis, management options include eyelid hygiene with warm compresses, eyelid scrubs, baby shampoo, and over-the-counter eyelid cleansers. Topical antibiotics and antibiotic-steroid combination drops/ointments for the eye and eyelid may accompany these. For posterior blepharitis/meibomian gland dysfunction (MGD), at-home warm compress or in-office administration of heat therapy/thermal pulsation treatment that aims to clear obstruction in the meibomian glands and restore meibum secretions to maintain a healthy tear film is recommended. In addition to the above treatment strategies, various other compounds to manage lid margin diseases are in the late stages of development. This review summarizes the available treatment modalities or those in the pipeline for treating blepharitis and MGD.
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Affiliation(s)
- Karolinne Maia Rocha
- From the Medical University of South Carolina, Storm Eye Institute, Charleston, South Carolina (Rocha); University of California, Irvine, Irvine, California (Farid); New York University, Langone, New York, New York (Raju); Wills Eye Institute, Sidney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, Pennsylvania (Beckman); Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania (Ayres); Virginia Eye Consultants, Norfolk, Virginia (Yeu); Ophthalmic Consultants of Boston and Tufts University School of Medicine, Boston, Massachusetts (Rao); Casey Eye Institute, Oregon Health & Science University, Portland, Oregon (Chamberlain); The Eye Institute of Utah, Salt Lake City, Utah (Zavodni); Eye Consultants of Atlanta and Georgia Eye Bank, Atlanta, Georgia (Lee); Department of Ophthalmology and Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California (Schallhorn); Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California (Garg); Scripps Clinic, La Jolla, California (Mah)
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Talha M, Haris Ali M, Fatima E, Nadeem A, Ahmed A, Nashwan AJ. Efficacy and Safety of Lotilaner Ophthalmic Solution (0.25%) for the Treatment of Demodex Blepharitis: A GRADE Assessed Systematic Review and Meta-Analysis of Observational & Experimental Studies. Am J Ophthalmol 2024; 264:8-16. [PMID: 38513948 DOI: 10.1016/j.ajo.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/06/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Several treatments have been in use for Demodex blepharitis, before the discovery of lotilaner, like tea tree oil and antibiotics; however, they either have irritable effects or systemic adverse effects, respectively. Lotilaner, a novel ectoparasiticide, has been proposed as a treatment for patients grappling with Demodex blepharitis. This review aims to assess the safety and efficacy of lotilaner in the treatment of Demodex blepharitis. DESIGN Systematic review and meta-analysis. METHODS An extensive search was conducted on PubMed, Cochrane Library, Scopus, and Google Scholar to find relevant literature till July 31, 2023 following the PRISMA guidelines. A total of 143 articles were retrieved by database searching, out of which 6 studies met the inclusion criteria and were included in the review. Four randomized controlled trials were included in the meta-analysis of mite eradication incidence. The review is registered with PROSPERO: CRD42023459997. RESULTS Lotilaner is effective in eradicating Demodex mites in individuals suffering from Demodex blepharitis according to RR for the intervention versus the control group of 3.55 (95% confidence interval [CI]: 2.87-4.40, P < .00001, I2 = 0%). The meta-analysis of clinically meaningful collarette score revealed the summary RR for the intervention versus the control group was 3.15 (95% CI: 2.56-3.89, P < 0.00001, I2 = 27%). In conclusion, the results of the included studies were comparable and consistent. CONCLUSIONS Our results indicated that lotilaner is an effective, well-tolerated, and promising drug in treating patients with Demodex blepharitis. Lotilaner administration and cost-effectiveness should now be contemplated for the study population as these constituents have a vital impact on its treatment success.
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Affiliation(s)
- Muhammad Talha
- Department of Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College (M.T., M.H.A.), Lahore, Pakistan
| | - Mohammad Haris Ali
- Department of Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College (M.T., M.H.A.), Lahore, Pakistan
| | - Eeshal Fatima
- Department of Medicine, Services Institute of Medical Sciences (E.F.), Lahore, Pakistan
| | - Arsalan Nadeem
- Department of Medicine, Allama Iqbal Medical College (A.N., A.A.), Lahore, Pakistan
| | - Abdullah Ahmed
- Department of Medicine, Allama Iqbal Medical College (A.N., A.A.), Lahore, Pakistan
| | - Abdulqadir J Nashwan
- Department of Nursing, Hamad Medical Corporation (A.J.N.), Doha, Qatar; Department of Public Health, College of Health Sciences, QU Health, Qatar University (A.J.N.), Doha, Qatar.
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Rijaul SKK, Maity N, Konar A, Hazra S. Topical Dexamethasone Counters Intravitreal Ivermectin-Induced Ocular Toxicity in a Rabbit Model. Curr Eye Res 2024; 49:750-758. [PMID: 38501588 DOI: 10.1080/02713683.2024.2330520] [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: 12/12/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Systemic use of Ivermectin has been reported to incite blindness in humans and veterinary patients. This study was designed to investigate the systemic and intravitreal effect of Ivermectin on ocular and retinal health and its attenuation with topical Dexamethasone. METHODS Systemic injection of Ivermectin@ 1.6 mg/kg S/C was administered, thrice a week for three weeks to New Zealand White rabbits (N = 4) with and without topical drops of Verapamil (N = 4). Pre and post-treatment ocular examination was conducted. At the end of three weeks the eyes were collected for histopathology.0.2 ml of Ivermectin solution (1.6 mg/ml) was injected intravitreally in one eye of the rabbit (N = 8), Half the rabbits received 0.1% dexamethasone drops thrice daily for 7 days, while the controls received PBS. Pre and post-treatment, detailed examination was conducted, which included the Schirmer Tear test, Fluorescein staining, Intraocular pressure, slit lamp biomicroscopy and fundus photography. The retina was harvested for histopathological and tunnel assay. RESULTS Systemic therapy with Ivermectin, with and without Verapamil did not incite any adverse response in the eye. Intravitreal Ivermectin evoked severe uveitis 4/4, cataract 3/4, corneal erosion 3/4 eyes and severe inflammatory response. Eyes that received dexamethasone were rescued from the adverse changes as demonstrated clinically, by histopathology and prevention of apoptosis. CONCLUSIONS Intravitreal Ivermectin incites severe inflammatory response. Topical dexamethasone counters the ocular toxicity incited by Ivermectin.
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Affiliation(s)
- S K K Rijaul
- Department of Veterinary Surgery & Radiology, West Bengal University of Animal and Fishery Sciences, Kolkata, India
| | - Namrata Maity
- Department of Veterinary Surgery & Radiology, West Bengal University of Animal and Fishery Sciences, Kolkata, India
| | | | - Sarbani Hazra
- Department of Veterinary Surgery & Radiology, West Bengal University of Animal and Fishery Sciences, Kolkata, India
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Amer MM, Ho JW, Theotoka D, Wall S, Galor A, Cheng A, Miller D, Karp CL. Role of Topical 5-Fluorouracil in Demodex -Associated Blepharitis. Cornea 2024; 43:720-725. [PMID: 38236070 PMCID: PMC11076173 DOI: 10.1097/ico.0000000000003470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 12/03/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE The aim of this study was to report clinical observations suggesting the efficacy of topical 1% 5-fluorouracil (5-FU) in treating Demodex -associated blepharitis. METHODS An observational retrospective review of 13 eyes from 13 individuals with conjunctival neoplastic lesions and concomitant Demodex lash infestation that received topical 1% 5-FU eye drops. Patients underwent slit-lamp examination at each follow-up visit. Clinical photographs of the lash line were obtained after treatment initiation. In a subset of patients, lashes were epilated bilaterally and microscopically analyzed for presence of Demodex mites before and after treatment initiation. RESULTS The mean age of the population was 68 ± 14 years (range: 30-84 years) and 92% were male. In all 13 patients, a marked reduction in cylindrical dandruff was noted in the treated eye by slit-lamp examination after 2 cycles of 5-FU. There was complete resolution of cylindrical dandruff in 10 of 13 treated eyes compared with 0 resolution of cylindrical dandruff in untreated eyes ( P = 0.0001). In the 6 patients who received epilation, the lashes from the treated eye showed no Demodex , whereas lashes from the fellow untreated eye revealed persistent Demodex . CONCLUSIONS Topical 1% 5-FU shows efficacy in treating Demodex -associated blepharitis. Further studies are indicated to reproduce our findings and evaluate the potential use of 5-FU as a treatment ingredient.
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Affiliation(s)
- Mona M. Amer
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Joanne W. Ho
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Despoina Theotoka
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Sarah Wall
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Anny Cheng
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Darlene Miller
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Carol L. Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
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Valvecchia F, Greco L, Perrone F, Logioco C, Caride GG, Perrone L, Valvecchia G, Albertazzi R, Zanutigh V. Topical ivermectin ointment treatment of Demodex blepharitis: a 6-year retrospective study. Graefes Arch Clin Exp Ophthalmol 2024; 262:1281-1288. [PMID: 37910180 DOI: 10.1007/s00417-023-06281-0] [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: 06/01/2023] [Revised: 10/07/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND To evaluate the efficacy of topical ivermectin 1% ointment, for the treatment of Demodex blepharitis. METHODS A retrospective study was designed to review electronic medical records of patients seen between January 2017 and December 2022, who had a diagnosis of Demodex blepharitis, treated with topical ivermectin 1% with at least 6 months of follow-up (Centro de Ojos Quilmes, Buenos Aires, Argentina). The presence of collarettes was graded from 0 to 4. An imaging system (Keratograph) was used, to evaluate tear meniscus height (TMH), non-invasive tear break-up time (NIKBUT), and degree of conjunctival redness. In addition, the ocular surface disease index (OSDI) test was performed. Results were compared before and after ivermectin treatment, which was performed once a day for 2 months. RESULTS A total of 2157 patients (4314 eyes) were included. The mean age was 50.43 ± 15.3 years, and the follow-up time was 26.1 ± 8.5 months. No one discontinued treatment due to intolerance, although 14 cases (0.6 %) reported occasional discomfort. The grade of collarettes decreased with statistical significance, from 3.37 ± 0.7 to 0.1 ± 0.3 (p < 0.01), as well as conjunctival redness from 1.32 ± 0.3 to 0.94 ± 0.4 (p < 0.01) and OSDI score from 58.74 ± 17.9 to 17.1 ± 10.5 (p = 0.02). TMH and NIKBUT improved without statistical difference. CONCLUSION Treatment with ivermectin 1% topical ointment, once daily for 2 months, was effective in reducing the presence of collarettes and in improving symptoms in patients with Demodex blepharitis.
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Affiliation(s)
- Florencia Valvecchia
- Centro de Ojos Quilmes, Humberto Primo 298, Quilmes, 1878, Buenos Aires, Argentina.
| | - Lourdes Greco
- Centro de Ojos Quilmes, Humberto Primo 298, Quilmes, 1878, Buenos Aires, Argentina
| | - Franco Perrone
- Centro de Ojos Quilmes, Humberto Primo 298, Quilmes, 1878, Buenos Aires, Argentina
| | - Celina Logioco
- Centro de Ojos Quilmes, Humberto Primo 298, Quilmes, 1878, Buenos Aires, Argentina
| | - Gaston Gomez Caride
- Centro de Ojos Quilmes, Humberto Primo 298, Quilmes, 1878, Buenos Aires, Argentina
| | - Luciano Perrone
- Centro de Ojos Quilmes, Humberto Primo 298, Quilmes, 1878, Buenos Aires, Argentina
| | - Gerardo Valvecchia
- Centro de Ojos Quilmes, Humberto Primo 298, Quilmes, 1878, Buenos Aires, Argentina
| | - Roberto Albertazzi
- Centro de Ojos Quilmes, Humberto Primo 298, Quilmes, 1878, Buenos Aires, Argentina
| | - Virginia Zanutigh
- Centro de Ojos Quilmes, Humberto Primo 298, Quilmes, 1878, Buenos Aires, Argentina
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Safir M, Twig G, Mimouni M. Dry eye disease management. BMJ 2024; 384:e077344. [PMID: 38527751 DOI: 10.1136/bmj-2023-077344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Margarita Safir
- Ophthalmology Department, Yitzhak Shamir Medical Center, Zerifin, Israel
- Faculty of Medicine, Tel Aviv University, Israel
| | - Gilad Twig
- Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Israel
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Michael Mimouni
- Ophthalmology Department, Rambam Health Care Campus, Haifa, Israel
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Smith M, Wolffsohn JS, Chiang JCB. Topical ivermectin 1.0% cream in the treatment of ocular demodicosis. Cont Lens Anterior Eye 2024; 47:102099. [PMID: 38049351 DOI: 10.1016/j.clae.2023.102099] [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: 09/26/2023] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023]
Abstract
PURPOSE Ocular demodicosis can cause debilitating ocular surface disease. As ivermectin is effective at reducing Demodex proliferation in rosacea, this study investigated the efficacy of topical ivermectin 1.0% cream in treating ocular demodicosis. METHODS This retrospective single-centre clinical practice chart analysis involved the off-label treatment of patients who had ocular demodicosis with topical ivermectin 1.0 % cream (Soolantra, Galderma Ltd, UK) applied nightly to the lid margins of both eyes for 3 months. Ocular surface health was assessed at baseline when the treatment was prescribed and followed up at 3 and 12 months after baseline. Slit lamp biomicroscopy was used to take digital images of the upper eyelid lashes. Manual image analysis with ImageJ was conducted by a masked assessor to quantify signs of ocular demodicosis including the number of lashes with collarettes, with visible Demodex tails and with follicle pouting. RESULTS Data from a total of 75 patients with ocular demodicosis were analysed for this study (mean age 66.6 ± 13.9 years, 44 female). The numbers of lashes with collarettes (Median [Interquartile range]: 8 [4-13] at baseline to 0 [0-2] at the final visit, p < 0.001) and lashes with follicle pouting (3 [1-5] at baseline to 0 [0-1.8] at the final visit, p < 0.001) decreased with treatment. Any sign of lashes with visible tails was eliminated by the final visit (p < 0.007). Fluorescein staining severity score also improved, particularly from baseline (1 [0-2]) to the second visit (0 [0-1], p < 0.001). CONCLUSIONS The findings of this study show evidence for the efficacy of a 3-month course of topical ivermectin 1.0% cream in treating ocular demodicosis as indicated by reduction in collarettes, follicle pouting and visible Demodex tails. More research is warranted to improve the diagnosis, management and monitoring of this condition which is often overlooked or misdiagnosed.
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Affiliation(s)
| | - James S Wolffsohn
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Jeremy Chung Bo Chiang
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom; School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
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Huang WL, Huang CM, Chu CY, Hu FR. Comorbidity of Ocular and Facial Demodicosis. Am J Ophthalmol 2024; 257:201-211. [PMID: 37739203 DOI: 10.1016/j.ajo.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE To determine the association between ocular and facial demodicosis, and the effect of facial treatment on ocular demodicosis. DESIGN Prospective clinical cohort study. METHODS Ocular demodicosis outpatients from a tertiary medical center were enrolled from April to December 2020. The diagnosis was based on epilation of 4 eyelashes from each upper eyelid. High ocular Demodex load (ODL) was defined as ≥8 mites per eye. Facial infestation was assessed by direct microscopic examination, with facial Demodex overgrowth (FDO) defined as a density >5 mites/cm2. All patients were prescribed 3 months of ocular treatment, and FDO patients received dermatologic treatment. RESULTS Eighty-nine patients were enrolled. Among those that completed the treatment course, 39 presented high ODL. Lower cylindrical sleeve counts were found in low ODL patients (low ODL vs high ODL: 8 vs 14, P = .009). FDO was less prevalent in this group (49% vs 77%, P = .012). The Ocular Surface Disease Index score decreased in patients without FDO (20.0 ± 17.1 to 14.0 ± 16.6, P = .027) after 3 months of topical tea tree oil treatment. Topical ivermectin treatment on the facial skin provided a higher ocular Demodex eradication rate in FDO patients (76% vs 16%, P < .001). CONCLUSION Concurrence of ocular and facial demodicosis is common, especially in cases of severe ocular demodicosis. Although ocular treatment alone is effective for patients with ocular demodicosis only, cotreatment with topical ivermectin on the facial skin enhances ocular Demodex eradication in patients with comorbid facial Demodex overgrowth.
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Affiliation(s)
- Wei-Lun Huang
- From the Department of Ophthalmology, National Taiwan University Hospital Hsinchu Branch (W.-L.H.), Hsinchu, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University (W.-L.H.), Taipei, Taiwan
| | - Chang-Ming Huang
- Department of Dermatology, National Taiwan University Hospital, College of Medicine, National Taiwan University (C.-M.H., C.-Y.C.), Taipei, Taiwan
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital, College of Medicine, National Taiwan University (C.-M.H., C.-Y.C.), Taipei, Taiwan
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University (F.-R.H.), Taipei, Taiwan.
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Paichitrojjana A, Chalermchai T. Comparison of in vitro Killing Effect of Thai Herbal Essential Oils, Tea Tree Oil, and Metronidazole 0.75% versus Ivermectin 1% on Demodex folliculorum. Clin Cosmet Investig Dermatol 2023; 16:1279-1286. [PMID: 37228784 PMCID: PMC10202699 DOI: 10.2147/ccid.s414737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
Background Abnormal proliferation of Demodex mites causes a skin disorder called demodicosis and has been linked to rosacea. The development of alternative therapy against Demodex mites is currently required. The ability to kill Demodex mites of Thai herbal essential oils has never been explored. This study aimed to study and compare the in vitro killing effect of Thai herbal essential oils, tea tree oil, and metronidazole 0.75% with ivermectin 1% on D. folliculorum. Materials and Methods D. folliculorum mites were collected from the wastes of diagnostic standardized skin surface biopsy samples of demodicosis and rosacea patients for the trial. The microscopic evaluation started immediately after the mites were exposed to immersion oil (negative control), Thai herbal essential oils, tea tree oil, metronidazole 0.75%, and ivermectin 1% (positive control). The survival times of ten mites from each test agent were compared. Results The efficacy of Thai herbal essential oils and other test agents can be arranged in order as follows: lemongrass oil > sweet basil oil > clove oil > tea tree oil > lesser galangal oil > ginger oil, kaffir lime oil, peppermint oil > citronella oil > galangal oil > cajeput oil > ivermectin 1% > metronidazole 0.75%. Conclusion This current study demonstrated the in vitro killing efficacy on D. folliculorum: Thai herbal essential oils, Tea tree oil > ivermectin 1% > metronidazole 0.75%. Thai herbal essential oils have the potential to be an adjuvant or alternative therapy against Demodex mites. Further in vivo studies are necessary to determine the treatment efficacy and side effects.
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Affiliation(s)
- Anon Paichitrojjana
- School of Anti-Aging and Regenerative Medicine, Mae Fah Luang University, Bangkok, Thailand
| | - Thep Chalermchai
- School of Anti-Aging and Regenerative Medicine, Mae Fah Luang University, Bangkok, Thailand
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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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Demodex Blepharitis: Its Role and Treatment in Ocular Surface Disease. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00300-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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