RESUMO
Demodex is a saprophytic mite of the ocular adnexa, which can in certain circumstances proliferate on the skin of the face and on the eyelid margins. It is involved in facial rosacea (especially in the papulopustular form) and in the development or aggravation of anterior and/or posterior blepharitis or even keratoconjunctivitis, often in association with cutaneous lesions ; the pathophysiology is often multifactorial. Symptoms are non-specific, but the presence of cylindrical sleeves on the eyelashes is very suggestive of infestation, and certain techniques of biomicroscopic examination or imaging, such as confocal microscopy in vivo, allow direct visualization of the parasite. Parasitological examination of the eyelashes can confirm the diagnosis and can be improved by good sampling technique. Eyelid hygiene and oil-based ointments are the cornerstone of treatment. New specific treatments, in particular topical treatments based on tea tree oil, ivermectin, as well as pulsed light therapy and micro-exfoliation of the eyelid margin, can help to reduce the parasitic load and improve symptoms.
Assuntos
Infecções Oculares Parasitárias , Ácaros/fisiologia , Animais , Blefarite/diagnóstico , Blefarite/tratamento farmacológico , Blefarite/epidemiologia , Infecções Oculares Parasitárias/diagnóstico , Infecções Oculares Parasitárias/tratamento farmacológico , Infecções Oculares Parasitárias/epidemiologia , Infecções Oculares Parasitárias/parasitologia , Pestanas/diagnóstico por imagem , Pestanas/parasitologia , Pestanas/patologia , Humanos , Higiene , Ivermectina/uso terapêutico , Ceratoconjuntivite/diagnóstico , Ceratoconjuntivite/tratamento farmacológico , Ceratoconjuntivite/epidemiologia , Ceratoconjuntivite/parasitologia , Glândulas Tarsais/diagnóstico por imagem , Glândulas Tarsais/parasitologia , Glândulas Tarsais/patologia , Microscopia Confocal , Óleo de Melaleuca/uso terapêuticoRESUMO
IDSs able to incorporate academic medical centers (AMCs) into their organizations can realize several benefits, including access to a broad spectrum of specialty services and clinical resources that can be used to develop clinical protocols and reduce variations in care delivery practices across the system. Before pursuing such a strategy, however, IDSs also must be ready to assume the challenges associated with managing AMCs. To effectively incorporate an AMC, an IDS will need to undertake cost-control initiatives within the AMC, implement an enterprisewide information system, and transform the AMC's culture to reflect a team-oriented, community-focused approach. Most importantly, the enterprisewide information system should provide a means to seamlessly integrate the AMC into the larger organization.