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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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Paduch R, Matysik-Woźniak A, Jünemann AG, Rejdak R. Tea tree oil influence on human keratocytes growth and viability. Exp Eye Res 2024:110013. [PMID: 39069001 DOI: 10.1016/j.exer.2024.110013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 07/30/2024]
Abstract
Tea tree oil (TTO) is used in ophthalmology to maintain healthy eyelid skin and to combat parasitic eyelid infections. Keratocytes belong to the structure of the corneal stoma and enable to maintain corneal homeostasis. TTO that reaches the surface of the eye in too high concentration may disturb the functions of these cells. The aim of the study was to test what concentration of TTO is safe for corneal keratocytes in vitro without causing a toxic effect. A normal human keratocytes (HK) cell line was used in the study. Morphology was visualized by light and fluorescence microscopy, cytometric analysis of the cell cycle and cytometric and spectrophotometric viability evaluation were performed. The level of nitric oxide was tested by Griess spectrophotometric method. TTO concentrations exceeding 0.01% significantly reduced cell viability. The IC50 values were on average 0.057%. Increasing TTO concentrations stimulated HK cells to release NOx. The observed values did not exceed 1 μM. The lowest TTO concentration increased the number of HK cells in the G1 phase of the cell cycle. Increasing TTO concentrations (≥0.1%) increased the number of cells in late apoptosis. TTO at concentrations ranging from 0.1% to 0.5% significantly changed cell morphology. Fluorescence analyzes confirmed that TTO at concentrations ≥0.1% induced apoptotic cell death. TTO exerts strong effect on ocular keratocytes depending on applied concentration. Concentrations exceeding 0.1% have a toxic effect on keratocytes, which die mainly by apoptosis. The ocular surface should be protected from excessive exposure to TTO, which may damage corneal stroma cells.
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Affiliation(s)
- Roman Paduch
- Department of Virology and Immunology, Institute Biological Sciences, Maria Curie-Skłodowska University, Akademicka 19, 20-033 Lublin, Poland; Department of General and Pediatric Ophthalmology, Medical University, Chmielna 1, 20-079 Lublin, Poland Lublin, Poland.
| | - Anna Matysik-Woźniak
- Department of General and Pediatric Ophthalmology, Medical University, Chmielna 1, 20-079 Lublin, Poland Lublin, Poland
| | - Anselm G Jünemann
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
| | - Robert Rejdak
- Department of General and Pediatric Ophthalmology, Medical University, Chmielna 1, 20-079 Lublin, Poland Lublin, Poland
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Misra S, Murthy SI, Joseph J. Clinical spectrum in microbiologically proven Demodex blepharokeratoconjunctivitis: An observational study. Indian J Ophthalmol 2024; 72:1049-1055. [PMID: 38459713 DOI: 10.4103/ijo.ijo_954_23] [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: 04/10/2023] [Accepted: 12/21/2023] [Indexed: 03/10/2024] Open
Abstract
PURPOSE To study the demographic, clinical, and microbiological profile of Demodex-related blepharokeratoconjunctivitis (BKC) at a tertiary eye care hospital. METHODS This retrospective observational study was conducted from January 2016 to September 2022. It included 83 patients with microbiologically proven Demodex BKC who presented to the cornea department of our tertiary care eye center. The clinical, microbiological, and demographic data of the 83 cases were analyzed. RESULTS Of the 83 cases, 57 (68.67%) were younger than 40 years, and 25 (30.12%) were below 20. Most patients presented with a good visual acuity of 20/40 or better (93 eyes; 84.55%). The disease was unilateral in 55 patients and bilateral in 28. Cylindrical dandruff was the predominant presentation noted in 61 eyes (54.95%), followed by corneal scarring in 47 eyes (42.34%) and corneal vascularization in 40 eyes (36.04%). On light microscopy, 87.95% of the positive samples were identified as Demodex folliculorum , 7.23% as Demodex brevis , and 6.02% remained unidentified. Tea tree oil and lid scrubs eradicated the disease in most patients clinically (75/83, 90.36%). CONCLUSION The spectrum of BKC includes both lid signs and corneal involvement. It can be a cause of recurrent BKC and detection of the mite by microscopic evaluation of the lashes can confirm the diagnosis. In most cases, the tea tree oil can effectively manage this condition. However, low doses of topical steroids are needed to control the inflammation in patients with corneal involvement.
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Affiliation(s)
- Sikha Misra
- Shantilal Shangvi Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Somasheila I Murthy
- Shantilal Shangvi Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
- The Ramoji Foundation Centre for Ocular Infections, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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Sadri E, Paauw JD, Ciolino JB, Nijm L, Simmons B, Meyer J, Gaddie IB, Berdy GJ, Holdbrook M, Baba SN, Jalalat P, Yeu E. Long-Term Outcomes of 6-Week Treatment of Lotilaner Ophthalmic Solution, 0.25%, for Demodex Blepharitis: A Noninterventional Extension Study. Cornea 2024:00003226-990000000-00481. [PMID: 38334465 DOI: 10.1097/ico.0000000000003484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/07/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE The aim of this study was to evaluate the long-term outcomes of lotilaner ophthalmic solution, 0.25%, in the treatment of Demodex blepharitis. METHODS This observational, extension study included patients with Demodex blepharitis (N = 239) who completed the Saturn-1 study and presented for the day 180 visit. All participants were assessed at days 180 and 365 after the initiation of 6-week treatment with the study drug or its vehicle. RESULTS The proportion of patients with 0 to 2 collarettes (grade 0) was significantly higher in the study group (N = 128 patients) than in the control group (N = 111 patients) (39.8% vs. 2.7% at day 180 and 23.5% vs. 2.9% at day 365; P < 0.0001). Similarly, the proportion of patients with ≤10 collarettes (collarette grade 0-1) in the study group was significantly higher than in the control group (70.3% vs. 18.0% at day 180 and 62.6% vs. 21.9% at day 365; P < 0.0001). In the study group, erythema continued to improve even after completion of the 6-week lotilaner treatment. No serious ocular adverse events were observed in the study group, and there was 1 treatment-related ocular adverse event in the study group, which was considered mild. CONCLUSIONS After 6-week treatment with lotilaner ophthalmic solution, 0.25%, for Demodex blepharitis, no long-term concerns were observed during 1 year of follow-up. A high proportion of patients with 0 to 2 collarettes (grade 0) or ≤10 collarettes (collarette grade of 0 or 1) was observed throughout 1 year of follow-up, indicating that the efficacy of lotilaner ophthalmic solution, 0.25%, against Demodex blepharitis may last well after completion of therapy.
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Affiliation(s)
| | | | | | - Lisa Nijm
- Warrenville Eye Care and LASIK Center, Warrenville, IL
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Sharma N, Martin E, Pearce EI, Hagan S. A Delphi approach to establishing consensus on best practice for the diagnosis and treatment of Demodex blepharitis. Cont Lens Anterior Eye 2024; 47:102080. [PMID: 37949731 DOI: 10.1016/j.clae.2023.102080] [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: 06/21/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
Demodex blepharitis does not have agreed standardized guidelines. The aim of this study was to classify signs and symptoms and to develop appropriate management strategies for Demodex blepharitis from a consensus of expert advice. METHODS A total of 11 anterior segment experts (ophthalmologists, optometrists and a contact lens optician) working in the United Kingdom participated in a modified 2-round Delphi panel. A mixed-methods approach was adopted and a survey questionnaire for round 1 was formulated, constructed from information in the available literature. Based on panel responses from round 1, feedback was provided and a round 2 questionnaire was formulated. More than two-thirds majority (72%) was used for consensus building. RESULTS Based on the clinical presentation of signs and symptoms along with associated conditions and risk factors, a diagnostic algorithm was proposed for the clinical investigation of Demodex blepharitis. A treatment algorithm was also proposed with first-line and second-line treatment recommendations for Demodex blepharitis. CONCLUSION The recommendation from this study provides the first effort in formulating clinical diagnostic algorithm and management guidelines for Demodex blepharitis. The guidelines include appropriate magnification on the slit lamp, associated signs, symptoms, risk factors and suggested management options. These guidelines can be used in a routine eyecare setting to encourage eyecare practitioners in tailoring the investigation and management of Demodex blepharitis.
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Affiliation(s)
- Nikhil Sharma
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
| | - Eilidh Martin
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
| | - Edward Ian Pearce
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
| | - Suzanne Hagan
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
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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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Awan B, Elsaigh M, Tariq A, Badee M, Loomba A, Khedr Y, Abdelmaksoud A. A Systematic Review and Meta-Analysis of the Safety and Efficacy of 0.25% Lotilaner Ophthalmic Solution in the Treatment of Demodex Blepharitis. Cureus 2024; 16:e52664. [PMID: 38380217 PMCID: PMC10878406 DOI: 10.7759/cureus.52664] [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] [Accepted: 01/20/2024] [Indexed: 02/22/2024] Open
Abstract
Demodex blepharitis is marked by an excessive presence of Demodex mites on the eyelids, particularly in the lash follicles. While these microscopic mites are a natural component of the skin microbiota, their overabundance can lead to ocular complications. Symptoms associated with Demodex blepharitis include eyelid itching, inflammation, and ocular irritation. Our objective is to investigate Lotilaner as a potential treatment for Demodex blepharitis, assessing both the safety and efficacy of the ophthalmic formula in managing this disease. We conducted research in Web of Science, PubMed, Cochrane Library, and Scopus up to November 2023. The quality of studies was evaluated using the Cochrane Risk of Bias tool, and it was employed to evaluate the quality of evidence. Our meta-analysis was executed using Review Manager 5.4. We evaluated the safety and efficacy of Lotilaner ophthalmic solution with a concentration of 0.25%. The following outcomes were assessed: clinically meaningful reduction in collarette, collarette cure, composite cure, drop comfort, erythema cure, mite density, and mite eradication. In the case of dichotomous data, we used the risk ratio (RR) with a 95% confidence interval (CI). In our analysis, all included studies, comprising a total of 891 participants, consistently reported clinically meaningful reductions in collarettes. The findings were statistically significant, with Lotilaner demonstrating a substantially higher reduction compared to the vehicle group (RR = 3.09, 95% CI [2.65-3.60]; P-value < 0.0001). Notably, results for Drop Comfort outcomes were nonsignificant, indicating no discernible differences compared to the group that used the vehicle (RR = 1.03, 95% CI [0.98-1.07]; P-value = 0.26). However, both mite density and mite eradication outcomes exhibited significant improvements with Lotilaner in comparison to the vehicle (RR = 2.58, 95% CI [2.25-2.95]; P-value < 0.0001) and (RR = 3.80, 95% CI [2.88-5.01]; P-value < 0.0001). The Lotilaner ophthalmic solution at 0.25% showed superior efficacy over the vehicle in reducing collarettes, achieving complete mite eradication within six weeks, and significantly decreasing erythema in Demodex blepharitis. It demonstrated safety with no reported side effects compared to the vehicle. Direct comparative studies with alternative treatments are recommended for a comprehensive assessment of efficacy and safety.
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Affiliation(s)
- Bakhtawar Awan
- Department of General and Emergency Surgery, Northwick Park Hospital, London, GBR
| | - Mohamed Elsaigh
- Department of General and Emergency Surgery, Northwick Park Hospital, London, GBR
| | - Areej Tariq
- Department of Opthalmology, Shaikh Zayed Hospital, Lahore, PAK
| | - Mohammed Badee
- Department of Ophthalmology, Perfect Vision Eye Hospital, Cairo, EGY
| | - Abhinav Loomba
- Department of Opthalmology, Hull University Teaching Hospitals NHS Trust, Hull, GBR
| | - Yahya Khedr
- Department of Opthalmology, Hull University Teaching Hospitals NHS Trust, Hull, GBR
| | - Ahmed Abdelmaksoud
- Department of Opthalmology, Hull University Teaching Hospitals NHS Trust, Cottingham, GBR
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Pyzia J, Mańkowska K, Czepita M, Kot K, Łanocha-Arendarczyk N, Czepita D, Kosik-Bogacka DI. Demodex Species and Culturable Microorganism Co-Infestations in Patients with Blepharitis. Life (Basel) 2023; 13:1827. [PMID: 37763231 PMCID: PMC10533081 DOI: 10.3390/life13091827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
We aimed to determine the prevalence of Demodex spp. and bacterial infection in patients with blepharitis and also to investigate the relationship between culturable microorganisms and Demodex spp. in this study. The study included patients diagnosed with blepharitis (n = 128) and volunteers without ocular problems (n = 113). Eyelash sampling was performed by epilating eight lashes, which were then tested for Demodex spp. using a light microscope. The examination consisted of assessing the patient's vision with and without ocular correction and tonus in both eyes and a careful examination of the anterior segment of both eyes. Bacterial identification was performed based on morphological, physiological, and biochemical methods. The prevalence of Demodex spp. was 8.0% in patients from the control group and all patients with blepharitis. Isolated forms of Demodex spp. were detected in all infested patients in the control group and in 58% of patients with blepharitis. A total of 35% of patients with blepharitis had from three to nine forms of Demodex spp., and 7% of patients with blepharitis had more than 10 mites in every field of vision. We found a statistically significant relationship between Demodex spp. infestation and the occurrence of eye dryness and sensations of burning and tearing, redness of the conjunctiva, feeling of a foreign body, loss of eyelashes, Meibomian gland dysfunction, and cylindrical dandruff. There were statistically significant relationships between Demodex sp. infestation and the presence of hyperopia, Meibomian cysts, chronic eyelid inflammation, and the use of eyeglasses. There was also a statistically significant relationship between the occurrence of Demodex spp. and seborrheic dermatitis and diabetes mellitus. Culturable microorganisms of the ocular surface were found in 8.7% of participants who were uninfested and in all patients infested with D. folliculorum. We isolated Staphylococcus aureus, Acinetobacter baumannii, Streptococcus pneumoniae, Klebsiella oxytoca, and Bacillus spp. from the conjunctival sac only in patients infested with D. folliculorum. This indicates an increased probability of colonization by pathogenic bacteria in patients with demodicosis. Therefore, patients infested with D. folliculorum should undergo a microbiological examination of conjunctival swabs.
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Affiliation(s)
- Joanna Pyzia
- Department of Ophthalmology, Independent Provincial Public Integrated Hospital “Arkońska”, Arkońska 4, 71-455 Szczecin, Poland;
| | - Katarzyna Mańkowska
- Department of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University, al. Powstańców Wielkpolskich 72, 70-111 Szczecin, Poland;
| | - Maciej Czepita
- Department of Ophthalmology, Pomeranian Medical University, al. Powstańców Wielkpolskich 72, 70-111 Szczecin, Poland
| | - Karolina Kot
- Department of Biology and Medical Parasitology, Pomeranian Medical University, al. Powstańców Wielkpolskich 72, 70-111 Szczecin, Poland (N.Ł.-A.)
| | - Natalia Łanocha-Arendarczyk
- Department of Biology and Medical Parasitology, Pomeranian Medical University, al. Powstańców Wielkpolskich 72, 70-111 Szczecin, Poland (N.Ł.-A.)
| | - Damian Czepita
- Department of Ophthalmology, Pomeranian Medical University, al. Powstańców Wielkpolskich 72, 70-111 Szczecin, Poland
| | - Danuta I. Kosik-Bogacka
- Independent Laboratory of Pharmaceutical Botany, Pomeranian Medical University, al. Powstańców Wielkpolskich 72, 70-111 Szczecin, Poland
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Boel C, Westerveld E, Kloos D, Goezinne F. Refining the Diagnostic Technique to Determine Prevalence of Demodex Mites in Eyelash Hair Follicles Within Standard Ophthalmic Practice: A Single-Center Outpatient Clinical Study. Clin Ophthalmol 2023; 17:2027-2036. [PMID: 37483841 PMCID: PMC10361280 DOI: 10.2147/opth.s407898] [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: 03/27/2023] [Accepted: 06/17/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose A high density of Demodex infestation in human eyelids and eyelash follicles has been implicated in a variety of ocular surface conditions. However, Demodex infestation often goes undiagnosed and untreated, due to an overlap in signs and symptoms with other sources of ocular surface inflammation. We sought to refine the diagnostic technique for outpatient assessment for Demodex infestation and determine prevalence of Demodex mites in the hair follicles of eyelashes from patients in a standard ophthalmic practice. Patients and Methods Patients recruited from a single outpatient ophthalmology clinic were examined for the presence of Demodex mites following standard ophthalmic consultation. During anterior segment biomicroscopic examination, investigators searched for cylindrical dandruff and collarettes around the base of patient eyelashes. These were removed, and individual eyelashes manipulated with tweezers to reveal Demodex mites. Presence of Demodex, cylindrical dandruff and collarettes, time taken to identify the first Demodex mite, mean number of Demodex mites per hair shaft, and patient-reported symptoms of blepharitis were recorded and analyzed to determine potential correlations. Results A total of 173 patients were recruited, of whom 106 were included in Demodex prevalence analyses. Demodex infestation was identified in 100/106 (94%) patients, with a mean time of 2 minutes and 20 seconds taken to find the first Demodex mite and a mean number of 3 mites identified per hair shaft. Presence of Demodex significantly correlated with the presence of cylindrical dandruff (98/106 [92%] patients; p < 0.001), but not with the presence of collarettes (62/106 [58%] patients; p = 0.230) or symptoms of blepharitis (15/106 [14%] patients; p = 0.591). Conclusion These results highlight the pervasiveness of Demodex infestation, predicted by the presence of cylindrical dandruff, in the eyelashes of patients in a standard ophthalmic practice. They support the use of a non-invasive diagnostic technique to allow fast, simple identification of Demodex by ophthalmologists and optometrists in outpatient clinical practice.
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Affiliation(s)
- Charlotte Boel
- Eyescan Rijswijk, Rijswijk, the Netherlands
- Department of Ophthalmology, University Hospital Brussels, Brussels, Belgium
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Sharma N, Martin E, Pearce EI, Hagan S, Purslow C. Demodex Blepharitis: A Survey-Based Approach to Investigate Knowledge, Attitudes, and Practices Among Optometrists in India. CLINICAL OPTOMETRY 2023; 15:55-64. [PMID: 37069856 PMCID: PMC10105579 DOI: 10.2147/opto.s403837] [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: 01/06/2023] [Accepted: 03/03/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE To investigate the knowledge, attitudes, and practice towards Demodex blepharitis among optometrists in India. METHODS The study was conducted in the form of an online survey using Research Electronic Data Capture (REDCap). The survey link was distributed via direct e-mail and social media platforms, and it was comprised of 20 questions divided into two sections. The first section focused on the practitioners' demographics and their views on the general health of the eyelid. The second section of the survey was specific and aimed at obtaining information on identifying and treating Demodex blepharitis, and was only completed by those respondents who looked for Demodex mites. RESULTS The survey was completed by 174 optometrists. The prevalence of blepharitis in the general population was judged by the respondents to be 40%, whereas the prevalence of Demodex mites was estimated to be 29%. Interestingly, the prevalence of Demodex mites in people with blepharitis was estimated to be 30%. This estimated prevalence was substantially lower than that reported in the literature on the subject. 66% of participants believed Demodex mites to be a significant cause of ocular discomfort, whereas only 30% of participants would intervene to diagnose and manage Demodex blepharitis in their patients. Optometrists differed in their preferred method of diagnosis and management of Demodex infestation in eyelids. CONCLUSION The result of this survey suggests that Demodex blepharitis is a highly under-diagnosed condition in India, with nearly 30% of surveyed optometrists managing this condition. The study also observed a lack of awareness and consensus among surveyed optometrists with regards to diagnosis and appropriate treatment methods to control Demodex infestation in eyelids.
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Affiliation(s)
- Nikhil Sharma
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Eilidh Martin
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Edward Ian Pearce
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Suzanne Hagan
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Christine Purslow
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, Wales, UK
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Yi L, Gao L, Lv L, Zhang B, Chen F, Yang F, Yan W, Jiang L, Li N, Lao Y, Lu J, Huang X. Therapeutic efficacy of metronidazole by needle-free jet injection combined with blue light therapy in Moderate-to-Severe facial acne vulgaris. J Cosmet Dermatol 2023; 22:569-576. [PMID: 36208057 DOI: 10.1111/jocd.15442] [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: 07/23/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acne vulgaris is one of the most common dermatological diseases. Some topical treatments for acne used in combination, such as blue light and topical antibiotics (such as metronidazole) by needle-free jet injection (NFJI), are becoming prevalent in clinical practice, but the efficacy remains uncertain. METHODS In order to investigate the effect of blue light combined with metronidazole by NFJI in the treatment of acne, the 251 enrolled patients were randomly assigned into the blue light group, metronidazole (MNZ) group, and MNZ + blue light group, and then received 6-weeks' treatment. A variety of objective and subjective methods such as clinical pictures, skin barrier physiological parameters (including trans-epidermal water loss (TEWL), stratum corneum hydration, facail surface sebum, erythema and pigmentation), the Investigator Global Assessment score, acne lesion count assessment, Patients' Self-Assessment, and VAS score were used to evaluate the efficacy and side effects of the treatments. RESULTS Compared to the baseline, the MNZ + blue light group showed significant improvement in acne lesion count reduction, TEWL, straum corneum hydration, facial surface sebum and erythema (p < 0.05). The MNZ + blue light group showed significant differences compared with the MNZ group and blue light group in terms of acne lesion count reduction and erythema (p < 0.05) Compared to the MNZ group, the MNZ + blue light group demonstrated significant improvement in TEWL and sebum (p < 0.05). While compared to the blue light group, the MNZ + blue light group showed significant improvement in hydration (p < 0.05). There was no statistically significant difference among the three groups in pigmentation (p > 0.05). CONCLUSION The combination of MNZ by NFJI and blue light has a synergistic effect and can relieve acne skin lesion within 6 weeks in the treatment of moderate and moderate-to-severe facial acne vulgaris, meanwhile, this method has a good safety.
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Affiliation(s)
- Lu Yi
- Department of Dermatology and Venereology/Cosmetic Dermatology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Lihua Gao
- Departments of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lv Lv
- Department of Breast and Thyroid surgery, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Bo Zhang
- Departments of Stomatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Fangru Chen
- Department of Breast and Thyroid surgery, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Fengyuan Yang
- Department of Dermatology and Venereology/Cosmetic Dermatology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Wenjie Yan
- Department of Dermatology and Venereology/Cosmetic Dermatology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Lijun Jiang
- Department of Breast and Thyroid surgery, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Nianzhen Li
- Department of Breast and Thyroid surgery, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Yuanqing Lao
- Department of Dermatology and Venereology/Cosmetic Dermatology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Jianyun Lu
- Departments of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xi Huang
- Department of Dermatology and Venereology/Cosmetic Dermatology, Affiliated Hospital of Guilin Medical University, Guilin, China
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Farid M, Ayres BD, Donnenfeld E, Gaddie IB, Gupta PK, Holland E, Lindstrom R, Pflugfelder SC, Karpecki PM, Nichols KK, Starr CE, Yeu E. Delphi Panel Consensus Regarding Current Clinical Practice Management Options for Demodex blepharitis. Clin Ophthalmol 2023; 17:667-679. [PMID: 36875531 PMCID: PMC9983333 DOI: 10.2147/opth.s399989] [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: 12/03/2022] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
Purpose To obtain consensus on Demodex blepharitis (DB) treatment using a modified Delphi panel process. Methods Literature search identified gaps in knowledge surrounding treatment of DB. Twelve ocular surface disease experts comprised the Demodex Expert Panel on Treatment and Eyelid Health (DEPTH). They completed a live roundtable discussion in addition to 3 surveys consisting of scaled, open-ended, true/false, and multiple-choice questions pertaining to the treatment of DB. Consensus for scaled questions using a 1 to 9 Likert scale was predefined as median scores of 7-9 and 1-3. For other question types, consensus was achieved when 8 of 12 panelists agreed. Results The experts agreed that an effective therapeutic agent for treatment of DB would likely decrease the necessity of mechanical intervention, such as lid scrubs or blepharoexfoliation (Median = 8.5; Range 2-9). When treating DB, panelists believed that collarettes serve as a surrogate for mites, and that eliminating or reducing collarettes should be the main clinical goal of treatment (Median = 8; Range 7-9). The panelists would treat patients with at least 10 collarettes, regardless of other signs or symptoms and agreed that DB can be cured, but there is always the possibility for a reinfestation (n = 12). There was also consensus that collarettes, and therefore mites, are the primary treatment target and the way by which clinicians can monitor patient response to therapy (Median = 8; Range 7-9). Conclusion Expert panelists achieved consensus on key facets of DB treatment. Specifically, there was consensus that collarettes are pathognomonic for DB, that DB patients with >10 collarettes should be treated even in the absence of symptoms, and that treatment efficacy can be tracked by collarette resolution. By increasing awareness about DB, understanding the goals of and monitoring treatment efficacy, patients will receive better care and, ultimately, better clinical outcomes.
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Affiliation(s)
- Marjan Farid
- Gavin Herbert Eye Institute, UC-Irvine, Irvine, CA, USA
| | | | | | | | - Preeya K Gupta
- Triangle Eye Consultants, Raleigh, NC and Tulane University, New Orleans, LA, USA
| | | | | | | | | | - Kelly K Nichols
- University of Alabama at Birmingham, School of Optometry, Birmingham, AL, USA
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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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