RESUMO
To observe the clinical changes of meibomian gland dysfunctipn (MGD) and ocular Demodex infestation after intense pulsed light (IPL) treatment to further examine the mechanism of IPL treating patients with MGD and ocular Demodex infestation. The medical records of 25 patients (49 eyes) with MGD treated with IPL, were retrospectively examined to determine outcomes. Associated ocular-surface parameters (ocular surface disease index, OSDI; lipid layer thickness, LLT; noninvasive first breakup time, NIF-BUT; noninvasive average breakup time, NIAvg-BUT; tear film breakup area, TBUA; Schirmer I Test, SIT; corneal fluorescein staining, CFS), eyelid margin abnormalities, meibum quality and expressibility, MG morphological parameters (macrostructure and microstructure), and the number of Demodex infestation were examined before and after treatment. The MG microstructure and the Demodex infestation were examined via in vivo confocal microscopy (IVCM). The results showed that there were statistically significant differences in associated ocular-surface parameters (all P<0.05) before and after IPL treatment, except SIT (P=0.065). Eyelid margin abnormalities, meibum quality and expressibility obviously improved in upper and lower eyelid after IPL treatment (all P<0.0001). MG macrostructure (MG dropouts) decreased in upper (P=0.002) and lower eyelid (P=0.001) after IPL treatment. The nine parameters of MG microstructure in upper and lower eyelid all distinctly improved after IPL treatment (all P<0.0001). The mean number of Demodex mites on the upper lid margin (6.59±7.16 to 3.12±3.81/9 eyelashes) and lower lid margin (2.55±2.11 to 1.29±1.53/9 eyelashes) significantly reduced after IPL treatment (all P<0.0001). The Demodex eradication rate was 20% (8/40) in upper lid margin and 34.15% (14/41) in lower lid margin. These findings indicate that IPL shows great therapeutic potential for patients of MGD and ocular Demodex infestation.
Assuntos
Terapia de Luz Pulsada Intensa/métodos , Disfunção da Glândula Tarsal/terapia , Glândulas Tarsais/efeitos da radiação , Infestações por Ácaros/terapia , Lágrimas/efeitos da radiação , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Pálpebras/parasitologia , Pálpebras/patologia , Pálpebras/efeitos da radiação , Feminino , Humanos , Masculino , Disfunção da Glândula Tarsal/parasitologia , Disfunção da Glândula Tarsal/patologia , Glândulas Tarsais/parasitologia , Glândulas Tarsais/patologia , Pessoa de Meia-Idade , Infestações por Ácaros/parasitologia , Infestações por Ácaros/patologia , Ácaros/patogenicidade , Ácaros/fisiologia , Ácaros/efeitos da radiação , Estudos Retrospectivos , Lágrimas/parasitologiaAssuntos
Imunossupressores/efeitos adversos , Infestações por Ácaros/induzido quimicamente , Terapia PUVA , Psoríase/tratamento farmacológico , Acitretina/uso terapêutico , Idoso , Animais , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Ceratolíticos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infestações por Ácaros/tratamento farmacológico , Infestações por Ácaros/patologia , Ácaros , Esteroides/efeitos adversos , Esteroides/uso terapêutico , Tacrolimo/efeitos adversos , Tacrolimo/análogos & derivados , Tacrolimo/uso terapêuticoRESUMO
The purpose of this study was to evaluate the relation between ocular discomfort and ocular Demodex infestation, and therapeutic effects of tea tree oil (TTO) in Demodex blepharitis patients. Three hundred and thirty-five patients with ocular discomfort were evaluated for ocular Demodex infestation and subjective symptoms with ocular surface discomfort index (OSDI) score. Among them, Demodex-infested patients were randomized to receive either eyelid scrubbing with TTO (TTO group,106 patients) or without TTO (Control group, 54 patients) for 1 month. Demodex were found in 84% of patients with ocular discomfort. The number of Demodex was significantly correlated with age (P = 0.04) and OSDI score (P = 0.024). After eyelid scrub treatment, Demodex count was reduced from 4.0 ± 2.5 to 3.2 ± 2.3 in the TTO group (P = 0.004) and from 4.3 ± 2.7 to 4.2 ± 2.5 in the control group (P = 0.27). Also, OSDI score was reduced from 34.5 ± 10.7 to 24.1 ± 11.9 in the TTO group (P = 0.001) and from 35.3 ± 11.6 to 27.5 ± 12.8 in the control group (P = 0.04). In conclusion, Demodex number showed a significant positive correlation with age and subjective ocular discomfort. The tea tree oil eyelid scrub treatment is effective for eliminating ocular Demodex and improving subjective ocular symptoms.
Assuntos
Blefarite/tratamento farmacológico , Infecções Oculares Parasitárias/tratamento farmacológico , Infestações por Ácaros/tratamento farmacológico , Óleo de Melaleuca/uso terapêutico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Animais , Anti-Infecciosos Locais/farmacologia , Anti-Infecciosos Locais/uso terapêutico , Blefarite/patologia , Infecções Oculares Parasitárias/parasitologia , Infecções Oculares Parasitárias/patologia , Pálpebras/parasitologia , Pálpebras/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infestações por Ácaros/parasitologia , Infestações por Ácaros/patologia , Ácaros/efeitos dos fármacos , Fitoterapia , Óleo de Melaleuca/farmacologia , Adulto JovemRESUMO
PURPOSE: To report clinical outcome of treating ocular demodecosis by lid scrub with tea tree oil (TTO). METHODS: Retrospective review of clinical results in 11 patients with ocular Demodex who received weekly lid scrub with 50% TTO combined with daily lid hygiene with tea tree shampoo. RESULTS: These 11 patients also had meibomian gland dysfunction (n = 7) manifesting abnormal lipid film with slow lipid film spread, intermittent trichiasis (n = 5), and subjective lash loss (n = 4), suggesting damage to the meibomian glands and lash follicles. In addition, conjunctival inflammation (n = 8) was associated with conjunctivitis (n = 5), conjunctivochalasis (n = 3), findings suspicious for pemphigoid (n = 2), and recurrent pterygium (n = 2). After TTO lid scrub, the Demodex count dropped to 0 for 2 consecutive visits in less than 4 weeks in 8 of 11 patients. Ten of the 11 patients showed different degrees of symptomatic relief and notable reduction of inflammatory signs. Significant visual improvement in 6 of 22 eyes was associated with a stable lipid tear film caused by significant reduction of lipid spread time. Lid scrub with 50% TTO caused notable irritation in 3 patients. CONCLUSION: Demodex potentially causes ocular surface inflammation, meibomian gland dysfunction, and lash abnormalities. Lid scrub with TTO can effectively eradicate ocular Demodex and result in subjective and objective improvements. This preliminary positive result warrants future prospective investigation of Demodex pathogenicity.
Assuntos
Anti-Infecciosos/uso terapêutico , Infecções Oculares Parasitárias/tratamento farmacológico , Doenças Palpebrais/tratamento farmacológico , Infestações por Ácaros/tratamento farmacológico , Fitoterapia , Óleo de Melaleuca/uso terapêutico , Administração Tópica , Animais , Infecções Oculares Parasitárias/parasitologia , Infecções Oculares Parasitárias/patologia , Pestanas/parasitologia , Pestanas/patologia , Doenças Palpebrais/parasitologia , Doenças Palpebrais/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infestações por Ácaros/parasitologia , Infestações por Ácaros/patologia , Estudos Retrospectivos , Termografia , Resultado do TratamentoRESUMO
AIMS: To compare the in vitro killing effect of different agents on Demodex and to report the in vivo killing effect of tea tree oil (TTO) on ocular Demodex. METHODS: Survival time of Demodex was measured under the microscope. Sampling and counting of Demodex was performed by a modified method. RESULTS: Demodex folliculorum survived for more than 150 minutes in 10% povidone-iodine, 75% alcohol, 50% baby shampoo, and 4% pilocarpine. However, the survival time was significantly shortened to within 15 minutes in 100% alcohol, 100% TTO, 100% caraway oil, or 100% dill weed oil. TTO's in vitro killing effect was dose dependent. Lid scrub with 50% TTO, but not with 50% baby shampoo, can further stimulate Demodex to move out to the skin. The Demodex count did not reach zero in any of the seven patients receiving daily lid scrub with baby shampoo for 40-350 days. In contrast, the Demodex count dropped to zero in seven of nine patients receiving TTO scrub in 4 weeks without recurrence. CONCLUSIONS: Demodex is resistant to a wide range of antiseptic solutions. Weekly lid scrub with 50% TTO and daily lid scrub with tea tree shampoo is effective in eradicating ocular Demodex.