ABSTRACT
Chronic mixed blepharitis accounts for 51.7% of all ophthalmic diseases. The use of laser Doppler flowmetry (LDF) in the diagnosis of this disease can help establish the initial manifestations of the inflammatory process in the eyelids, which is important for the prevention of possible complications - dry eye disease. PURPOSE: This study was conducted to determine the sensitivity and specificity of the LDF method in the diagnosis of chronic mixed blepharitis based on the study of microcirculatory changes in the eyelid skin. MATERIAL AND METHODS: The study included 23 patients with chronic mixed blepharitis (mean age 67±5.8 years) and 18 healthy volunteers (mean age 63±1.1 years). LDF was performed using the LAZMA MC-1 device. ROC analysis was used to determine sensitivity and specificity. RESULTS: A typical disturbance of the eyelid skin microcirculation was revealed in chronic mixed blepharitis - ischemia - with inhibition of the intensity of the functioning of blood flow regulatory systems and moderate activation of the lymph flow. The sensitivity and specificity of the coefficient of variation (reflecting the vasomotor activity of microvessels) of blood flow was 71.43 and 71.43%, lymph flow - 65.71 and 80.00%; myogenic rhythms of blood flow - 83.33 and 85.71%, lymph flow - 66.67 and 71.43%; neurogenic rhythms of blood flow - 75.00 and 78.57%, lymph flow - 91.67 and 78.57%, respectively. CONCLUSION: Laser Doppler flowmetry of the eyelid skin in combination with clinical, functional and instrumental research methods helped reveal with high sensitivity and specificity the eyelid damage in chronic mixed blepharitis. This method allows assessment of the condition of the eyelids in individuals without diseases of the anterior segment of the eye.
Subject(s)
Blepharitis , Laser-Doppler Flowmetry , Microcirculation , Humans , Blepharitis/diagnosis , Blepharitis/physiopathology , Blepharitis/etiology , Laser-Doppler Flowmetry/methods , Male , Female , Aged , Middle Aged , Microcirculation/physiology , Sensitivity and Specificity , Eyelids/blood supply , Eyelids/physiopathology , Chronic Disease , Reproducibility of ResultsABSTRACT
INTRODUCTION: Chronic blepharitis is a common cause of eye irritation and dryness. They are often treated without regard to causal factors such as parasites which are rarely mentioned. AIM: To describe the role of Demodex in the pathogenesis of chronic blepharitis, to analyze the epidemiological, clinical, diagnostic and therapeutic particularities. METHODS: This is a prospective, case-control study conducted in the mycology parasitology department at the Habib Bourguiba university hospital in Sfax covering 100 cases with chronic blepharitis and 87 control cases. Clinical examination and eyelash removal were performed with direct examination for qualitative and quantitative analysis, before and after treatment. RESULTS: Demodex was significantly more found in patients than in controls (48% vs 13.8%). The quantitative analysis showed a significant difference between the two groups with 52.1% of Demodex (+++) for patients versus 8.3% for controls. Demodex blepharitis were treated with yellow oxid mercure ophthalmic ointment with a good outcome in 81,3%. CONCLUSION: Although it is admitted to be a saprophyte of the skin, a large number of arguments argues for the incrimination of Demodex in the etiopathogenesis of chronic blepharitis, hence the interest of eyelashes examination and a parasitic research in front of any chronic blepharitis resistant to usual treatments. In case of positive research, a specific treatment should be prescribed. Its effectiveness is another argument for the etiological diagnosis.
Subject(s)
Blepharitis , Mite Infestations , Mites , Animals , Humans , Prospective Studies , Mite Infestations/diagnosis , Mite Infestations/epidemiology , Mite Infestations/therapy , Tunisia , Case-Control Studies , Blepharitis/diagnosis , Blepharitis/epidemiology , Blepharitis/etiology , Chronic DiseaseABSTRACT
INTRODUCTION: Atopic dermatitis (AD), a chronic type 2 inflammatory skin disease, is frequently associated with ocular surface diseases (OSD) which may appear or worsen under anti-type 2-targeted treatments. However, the exact prevalence of OSD and the ophthalmology referral criteria remain ill-defined in AD patients before initiating such biotherapies. We aimed to characterize the prevalence, the nature and the factors related to OSD development in AD that may justify an ophthalmological management. METHODS: A total of 98 consecutive AD inpatients without biological treatment were retrospectively included. These were systematically evaluated by an ophthalmologist during their dermatological care. Clinical and laboratory data were analysed to characterize OSD and their risk factors. RESULTS: OSD were found in 83/98 AD patients (85%); mainly dry eye syndrome (64%, 63/98), allergic conjunctivitis (42%, 41/98), posterior (33%, 32/98), and anterior blepharitis (27%, 26/98). In AD patients without ocular symptoms, OSDs were also frequently found (63%, 12/19) and were mostly mild. Risk factors for OSD were history of allergic rhinitis, allergic sensitization, head and neck AD, ocular symptoms (foreign body sensation in the eye, burning, itching, photophobia), and total IgE level >3,000 kU/L. CONCLUSION: The prevalence of OSD was high, even in asymptomatic patients. The risk factors identified may indicate the need for ophthalmological examination for therapeutic management, especially when biological agents targeting type 2 inflammation are considered.
Subject(s)
Dermatitis, Atopic , Humans , Dermatitis, Atopic/complications , Dermatitis, Atopic/epidemiology , Male , Female , Retrospective Studies , Adult , Middle Aged , Prevalence , Risk Factors , Dry Eye Syndromes/epidemiology , Dry Eye Syndromes/etiology , Dry Eye Syndromes/diagnosis , Conjunctivitis, Allergic/epidemiology , Conjunctivitis, Allergic/complications , Young Adult , Blepharitis/epidemiology , Blepharitis/etiology , Adolescent , Aged , Eye Diseases/epidemiology , Eye Diseases/etiologyABSTRACT
BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disorder associated with various systemic and ocular complications. This study aimed to investigate the prevalence, risk factors, and clinical characteristics of ocular complications in a cohort of Korean AD patients. METHODS: A retrospective review of medical records was conducted for AD patients who visited the dermatology and ophthalmology clinics at the same institution. Demographic data, clinical characteristics, and types of ocular complications were recorded. Logistic regression analysis was performed to identify factors associated with ocular complications. RESULTS: A total of 212 AD patients were included in the study. The intraocular complications had a prevalence of 1.9%, whereas ocular surface diseases were observed more frequently, with prevalence of 13.2%. Among the ocular complications, blepharitis was the most prevalent, followed by atopic keratoconjunctivitis. Subcapsular cataract, atrophic hole, and retinal detachment were also observed. The head and neck score in the Eczema Area and Severity Index (EASI) emerged as a significant predictor for intraocular complications, independent of age, gender, total EASI score, and family history. No significant association was found between total EASI score and ocular surface disease. CONCLUSION: This study provides insights into the prevalence and risk factors of ocular complications in Korean AD patients. The head and neck score in EASI was identified as a significant predictor for intraocular complications. These findings emphasize the importance of comprehensive evaluation and interdisciplinary care for AD patients, particularly in identifying and managing potential vision-threatening complications.
Subject(s)
Dermatitis, Atopic , Severity of Illness Index , Humans , Dermatitis, Atopic/epidemiology , Dermatitis, Atopic/complications , Male , Female , Republic of Korea/epidemiology , Retrospective Studies , Adult , Prevalence , Young Adult , Middle Aged , Adolescent , Risk Factors , Child , Blepharitis/epidemiology , Blepharitis/etiology , Child, Preschool , Eye Diseases/epidemiology , Eye Diseases/etiology , Cataract/epidemiology , Keratoconjunctivitis/epidemiology , Aged , Conjunctivitis, Allergic/epidemiology , Conjunctivitis, Allergic/complicationsABSTRACT
Rosacea is a chronic inflammatory dermatosis typically affecting the facial skin but also the eyes. With its chronic course with fluctuating episodes of flashing, redness, papulopustules, and nodules it poses a severe psychologic burden to the affected individuals. In addition to the facial changes, more than half of the patients have ocular involvement ranging from blepharitis and conjunctival hyperemia to more severe ophthalmic damage, and even blindness. Clinically, the ocular involvement in rosacea includes meibomian gland dysfunction with relapsing hordeola and chalazia, diffuse hyperemic conjunctivitis, photophobia, episcleritis, or kerato-conjunctivitis, and in rare cases, corneal ulcers. These are mainly observed in adult patients but can also occur in children. Depending on the degree of cutaneous or ocular findings, patients with rosacea may present first to the dermatologist or to the ophthalmologist. Both specialists should be aware of the potential oculocutaneous involvement. Any ocular complaints expressed by the patient in the setting of a dermatologist's office should be referred promptly for an ophthalmologic examination. Conversely, signs suggestive of rosacea in the eye should lead the ophthalmologist to consider underlying skin disease. A timely interdisciplinary collaboration is paramount for the earlier diagnosis and treatment, thus preventing permanent eye impairment in this chronic dermatosis.
Subject(s)
Blepharitis , Conjunctivitis , Rosacea , Skin Diseases , Child , Adult , Humans , Rosacea/diagnosis , Rosacea/therapy , Eye , Blepharitis/diagnosis , Blepharitis/etiology , Blepharitis/therapyABSTRACT
Eyelid dermatitis may present with a variety of clinical findings including erythema, pruritus, and edema, and it has a wide differential. Allergic contact dermatitis due to allergen sources in personal care products, cosmetics, and fragrances is a leading cause of eyelid dermatitis and may be challenging to diagnose by clinical examination alone. Expanded patch testing, in addition to careful inspection of the surrounding skin for additional areas of involvement and clinical clues, remains an important tool in differentiating allergic contact dermatitis from other relevant etiologies of eyelid dermatitis including irritant contact dermatitis, atopic dermatitis, seborrheic dermatitis, and rosacea. We present a practical approach to the management of eyelid dermatitis including the use of a topical anti-inflammatory for long-term control of eyelid findings. Further diagnostic workup may be warranted in patients with refractory eyelid dermatitis.
Subject(s)
Blepharitis , Cosmetics , Dermatitis, Allergic Contact , Dermatitis, Atopic , Humans , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Allergic Contact/etiology , Dermatitis, Atopic/diagnosis , Eyelids , Allergens/adverse effects , Cosmetics/adverse effects , Patch Tests/adverse effects , Blepharitis/diagnosis , Blepharitis/etiology , Blepharitis/therapyABSTRACT
Blepharitis is a chronic condition and full recovery is difficult to achieve. It requires good patient compliance and an individual treatment regime. There are many conditions which can cause blepharitis, and it is essential to find the cause to give the proper treatment. There is scarce evidence for the recommended guidelines. Blepharitis itself rarely causes vision loss, but in case of complications like keratitis it is more frequently observed. When patients do not respond to the treatment it is important to consider if it is caused by immunological diseases or carcinoma, as argued in this review.
Subject(s)
Blepharitis , Keratitis , Humans , Blepharitis/diagnosis , Blepharitis/drug therapy , Blepharitis/etiology , Chronic DiseaseABSTRACT
PURPOSE: To determine whether there is an increased incidence of Demodex of the eyelashes among patients after cataract extraction surgery. DESIGN: Prospective, noncomparative clinical study. METHODS: A cohort of patients who underwent cataract extraction surgery had several eyelashes removed preoperatively that were examined independently by the hospital laboratory for the presence of the Demodex mite. This was repeated 3 weeks after surgery. During several postoperative weeks, patients received the standard treatment of steroid drops alone for a period as individually required. RESULTS: A total of 62 patients were included in the study (31 men and 31 women), with a mean age of 71.04 years (range, 47-87). In the group positive for Demodex, the male-to-female ratio was 2:3 (P = .2772). Demodex colonization was observed in 22.58% of samples before cataract surgery and in 32.26% after cataract surgery and topical postoperative steroid therapy (P = .0143). CONCLUSIONS: There is a statistically significant increase in Demodex colonization of eyelashes after cataract surgery and postoperative topical steroid treatment. Although Demodex colonization does not necessarily cause blepharitis, our findings of increased colonization should raise the possibility of Demodex blepharitis being considered by ophthalmologists in patients with chronic postoperative eye discomfort after cataract surgery. This study was carried out at the Emek Medical Center.
Subject(s)
Blepharitis , Cataract Extraction , Cataract , Eye Infections, Parasitic , Eyelashes , Mite Infestations , Mites , Humans , Male , Female , Aged , Animals , Mite Infestations/diagnosis , Mite Infestations/drug therapy , Mite Infestations/epidemiology , Prospective Studies , Blepharitis/diagnosis , Blepharitis/drug therapy , Blepharitis/etiology , Cataract Extraction/adverse effects , Eye Infections, Parasitic/diagnosis , Eye Infections, Parasitic/drug therapy , Eye Infections, Parasitic/epidemiologyABSTRACT
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.
Subject(s)
Blepharitis , Eye Infections, Parasitic , Eyelashes , Keratitis , Mite Infestations , Mites , Adult , Humans , Animals , Mite Infestations/diagnosis , Mite Infestations/drug therapy , Blepharitis/diagnosis , Blepharitis/drug therapy , Blepharitis/etiology , Inflammation , Keratitis/complications , Eye Infections, Parasitic/complications , Eye Infections, Parasitic/diagnosis , Eye Infections, Parasitic/drug therapySubject(s)
Biotinidase Deficiency , Blepharitis , Cheilitis , Lip Diseases , Blepharitis/diagnosis , Blepharitis/etiology , Cheilitis/diagnosis , Cheilitis/etiology , Humans , MaleABSTRACT
PURPOSE: To evaluate the safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to Demodex infestation compared to vehicle control. METHODS: In this phase II, randomized, controlled, double-masked clinical trial, 60 eligible participants with Demodex blepharitis were randomly assigned in a 1:1 ratio to receive either topical lotilaner ophthalmic solution, 0.25% (Tarsus Pharmaceuticals, Inc., Irvine, CA) (study group) or the vehicle without lotilaner (control group) bilaterally twice a day for 28 days. Participants were followed at Days 7, 14, 28, 60 and 90. The efficacy parameters were change in collarette grade and Demodex density at Day 28. Safety parameters were adverse events, changes in corrected distance visual acuity (CDVA), intraocular pressure (IOP) and slit-lamp biomicroscopy. RESULTS: The study group showed a statistically significant decrease in collarette grade compared to the control group beginning at Day 14 (p = 0.003) in the upper eyelid and at Day 28 (p = 0.003) in the lower eyelid. Decreases in both lids were maintained through Day 90 (p < 0.001). At Day 28, mite eradication was achieved in 66.7% and 25.9% of eyes in the study and control group (p = 0.005); at Day 90, these proportions were 68.2% and 18.5% (p = 0.001), respectively. No serious adverse events or clinically significant changes in CDVA and IOP were observed. CONCLUSION: For Demodex blepharitis, treatment with lotilaner ophthalmic solution, 0.25% for 4 weeks is safe and effective. The improvement in collarette grade and mite density observed during the treatment period persisted for at least two months following treatment cessation.
Subject(s)
Blepharitis , Eyelashes , Mite Infestations , Mites , Animals , Blepharitis/diagnosis , Blepharitis/drug therapy , Blepharitis/etiology , Humans , Mite Infestations/complications , Mite Infestations/drug therapy , Ophthalmic Solutions , Oxazoles , ThiophenesABSTRACT
Rosacea is a chronic progressive disease that causes inflammation on the skin and the ocular surface. This study aimed to evaluate the effects of Demodex mites on clinical findings associated with rosacea. Sixty patients who were newly diagnosed with rosacea in the dermatology outpatient clinic underwent superficial skin biopsy to determine the density of Demodex species. The patients were evaluated as Demodex positive (n=30) or Demodex negative (n=30) based on the species density. The 60 patients were examined in the ophthalmology outpatient clinic; a total of 120 eyes underwent tear breakup time (TBUT) and Schirmer tests and were examined for meibomitis and blepharitis findings. The demographic characteristics and ocular findings of both groups were recorded and statistically compared. We found that Demodex mite-related inflammation in rosacea does not significantly affect clinical ocular surface findings and that Demodex positivity is significantly associated with papulopustular rosacea (PPR)(P=.003).
Subject(s)
Blepharitis , Mite Infestations , Mites , Rosacea , Animals , Blepharitis/diagnosis , Blepharitis/etiology , Humans , Mite Infestations/complications , Mite Infestations/diagnosis , Rosacea/complications , Rosacea/diagnosis , SkinABSTRACT
Ocular graft-versus-host disease (oGVHD) is a fast progressing, autoimmunological disease following hematopoietic stem cell transplantation, leading to severe inflammation of the eye and destruction of the lacrimal functional unit with consecutive sight-threatening consequences. The therapeutic "window of opportunity" is narrow, and current treatment options are limited and often insufficient. To achieve new insights into the pathogenesis and to develop new therapeutic approaches, clinically relevant models of oGVHD are desirable. In this study, the ocular phenotype was described in a murine, chemotherapy-based, minor-mismatch GVHD model mimicking early-onset chronic oGVHD, with corneal epitheliopathy, inflammation of the lacrimal glands, and blepharitis. Additionally, corneal lymphangiogenesis was observed as part of oGVHD pathogenesis for the first time, thus opening up the investigation of lymphangiogenesis as a potential therapeutic and diagnostic tool.
Subject(s)
Antineoplastic Agents/toxicity , Blepharitis/pathology , Cornea/blood supply , Graft vs Host Disease/pathology , Hematopoietic Stem Cell Transplantation/adverse effects , Inflammation/pathology , Lacrimal Apparatus/pathology , Animals , Blepharitis/etiology , Blepharitis/metabolism , Disease Models, Animal , Female , Graft vs Host Disease/etiology , Graft vs Host Disease/metabolism , Inflammation/etiology , Inflammation/metabolism , Lacrimal Apparatus/metabolism , Lymphangiogenesis , Mice , Mice, Inbred C57BLABSTRACT
Ocular rosacea is a chronic inflammatory condition that can occur in the absence of cutaneous features. The most common ocular features are chronic blepharoconjunctivitis with eyelid margin inflammation and meibomian gland dysfunction. Corneal complications include corneal vascularization, ulceration, scarring and, rarely, perforation. Diagnosis is largely based on clinical signs, although it is often delayed in the absence of cutaneous changes, particularly in children. It can also be associated with systemic disorders such as cardiovascular disease. Management ranges from local therapy to systemic treatment, depending on the severity of the disease. In this review, we describe the epidemiology, pathophysiology, clinical features and treatment of rosacea and ocular rosacea.
Subject(s)
Blepharitis , Conjunctivitis , Rosacea , Blepharitis/diagnosis , Blepharitis/epidemiology , Blepharitis/etiology , Child , Cornea , Humans , Meibomian Glands , Rosacea/diagnosis , Rosacea/epidemiology , Rosacea/therapyABSTRACT
INTRODUCTION: Demodex mite is an external parasite which is implicated in various ocular conditions like anterior blepharitis, posterior blepharitis, meibomian gland dysfunction, chalazia and others. Although demodex has been shown to be a causative agent of chalazia, occurrence of a solitary inflammatory nodule due to demodex infestation has not been reported in literature. CASE: Our case describes the occurrence of an upper eyelid mass in a 62-year-old female which was found to have an associated demodex infestation. CONCLUSION: This is the first report of demodex infestation presenting as a nodular eyelid mass. This parasite needs to be considered in the differential diagnosis of eyelid masses as this condition requires specific management.
Subject(s)
Blepharitis , Chalazion , Eye Infections, Parasitic , Eyelashes , Mite Infestations , Mites , Animals , Blepharitis/diagnosis , Blepharitis/etiology , Chalazion/complications , Chalazion/diagnosis , Eye Infections, Parasitic/diagnosis , Eye Infections, Parasitic/parasitology , Eyelashes/parasitology , Female , Humans , Meibomian Glands/parasitology , Middle Aged , Mite Infestations/complications , Mite Infestations/diagnosis , Mite Infestations/epidemiologyABSTRACT
BACKGROUND: Eyelid dermatitis is a common dermatologic complaint. OBJECTIVE: To characterize patients with eyelid dermatitis. METHODS: Retrospective analysis (1994-2016) of North American Contact Dermatitis Group data. RESULTS: Of 50,795 patients, 2332 (4.6%) had eyelid dermatitis only, whereas 1623 (3.2%) also had dermatitis of the eyelids and head or neck. Compared with patients without eyelid involvement (n = 26,130), groups with eyelid dermatitis only and dermatitis of the eyelid and head or neck were significantly more likely to be female, white, and older than 40 years, and to have a history of hay fever, atopic dermatitis, or both (P < .01). Final primary diagnoses included allergic contact dermatitis (eyelid dermatitis only: 43.4%; dermatitis of the eyelid and head or neck: 53.5%), irritant contact dermatitis (eyelid dermatitis only: 17.0%; dermatitis of the eyelid and head or neck: 9.8%), and atopic dermatitis (eyelid dermatitis only: 13.1%; dermatitis of the eyelid and head or neck: 13.8%). Top 5 currently relevant allergens included nickel sulfate (eyelid dermatitis only: 18.6%; dermatitis of the eyelid and head or neck: 22.5%), fragrance mix I (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 18.3%), methylisothiazolinone (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 17.7%), gold sodium thiosulfate (eyelid dermatitis only: 14.7%; dermatitis of the eyelid and head or neck: 11.4%), and balsam of Peru (eyelid dermatitis only: 11.9%; dermatitis of the eyelid and head or neck: 12.6%). Both eyelid-involvement groups were significantly more likely to react to gold sodium thiosulfate, carmine, shellac, dimethylaminopropylamine, oleamidopropyl dimethylamine, and thimerosal (P < .05) compared with the no eyelid involvement group. LIMITATIONS: Lack of specific distribution patterns of eyelid dermatitis and no long-term follow-up data. CONCLUSION: Patch testing remains a critical tool in evaluating patients with eyelid dermatitis.
Subject(s)
Blepharitis/epidemiology , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Atopic/diagnosis , Dermatitis, Seborrheic/diagnosis , Adult , Allergens/adverse effects , Blepharitis/etiology , Cosmetics/adverse effects , Dermatitis, Allergic Contact/etiology , Dermatitis, Atopic/etiology , Dermatitis, Occupational/diagnosis , Dermatitis, Occupational/etiology , Dermatitis, Seborrheic/etiology , Europe/epidemiology , Eyelids/pathology , Female , Head/pathology , Humans , Irritants/adverse effects , Male , Metals/adverse effects , Middle Aged , Neck/pathology , Organ Specificity , Patch Tests , Perfume/adverse effects , Preservatives, Pharmaceutical/adverse effects , Retrospective Studies , Surface-Active Agents/adverse effects , Thiazoles/adverse effects , Thimerosal/adverse effects , United States/epidemiologySubject(s)
Blepharitis/microbiology , Pyoderma/pathology , Skin Diseases, Bacterial/pathology , Stomatitis/pathology , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Antiviral Agents/therapeutic use , Blepharitis/diagnosis , Blepharitis/etiology , Blepharitis/pathology , Crohn Disease/complications , Diagnosis, Differential , Female , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Herpes Simplex/genetics , Humans , Middle Aged , Mouth Mucosa/pathology , Mouth Mucosa/virology , Pyoderma/microbiology , Salmonella/genetics , Salmonella/isolation & purification , Skin Diseases, Bacterial/complications , Skin Diseases, Bacterial/microbiology , Skin Diseases, Bacterial/virology , Stomatitis/diagnosis , Stomatitis/virology , Treatment OutcomeABSTRACT
PURPOSE: There is increasing clinical and research interest in the potential contribution of Demodex to ocular surface disease. The aim of this systematic review was to summarise and synthesise current clinical evidence relating to the aetiology, diagnosis and treatment of ocular Demodex. RECENT FINDINGS: A comprehensive literature search was performed in OVID Medline, OVID Embase, and clinical trial registries, for studies published between 1990 and August 2019, examining Demodex on the ocular surface. The review included primary clinical research studies and systematic reviews of primary clinical research studies, where Demodex was considered in the context of the ocular surface and/or adnexa. Studies were categorised using the National Health and Medical Research Council evidence hierarchy. Risk of bias assessment was performed using validated tools for studies categorised as providing Level I or II evidence. A total of 87 studies were eligible for inclusion, including two systematic reviews. Most studies (60%) were observational, describing the prevalence of ocular Demodex in different clinical populations. There was a high degree of variability in the epidemiological data derived from cross-sectional aetiology studies. There was mostly consistent evidence to support an association between ocular Demodex and chronic blepharitis. Seven diagnostic test-accuracy studies were identified, which considered a range of techniques, including slit lamp examination for cylindrical eyelash collarettes and/or eyelash manipulation techniques, light microscopic evaluation of epilated eyelashes and in vivo confocal microscopy. There is currently no accepted gold-standard diagnostic method for ocular Demodex. For intervention studies, there was one systematic review, 11 published randomised trials, six trial registry entries, and nine case series. Despite a number of recent trials, the appropriate treatment regimen for ocular Demodex (including the optimal criteria and timing of an intervention) is not clearly established. CONCLUSIONS: This comprehensive narrative synthesis has captured the landscape of clinical evidence relating to the prevalence, aetiology, diagnosis and treatment of ocular Demodex. There remain opportunities to enhance understanding of its role in ocular surface disease, best diagnostic approaches and optimal treatment protocols.
Subject(s)
Blepharitis/etiology , Eye Infections, Parasitic/etiology , Eyelashes/parasitology , Mite Infestations/complications , Animals , Blepharitis/diagnosis , Blepharitis/parasitology , Eye Infections, Parasitic/diagnosis , Eye Infections, Parasitic/parasitology , Eyelashes/pathology , Humans , Microscopy, Confocal , Mite Infestations/parasitologyABSTRACT
The purpose of this randomized clinical trial is to evaluate the effect of eyelid hygiene on subjective symptoms, anterior blepharitis, and meibomian gland dysfunction (MGD) after cataract surgery. Subjects with obstructive MGD who underwent cataract surgery were randomly divided into two groups. In the eyelid hygiene group, eyelid hygiene was performed twice a day for 10 days from 3 days before to 1 week after cataract surgery. The control group did not perform eyelid hygiene. A subjective symptom questionnaire of SPEED, anterior blepharitis grade, and meibum quality and quantity was evaluated at baseline and at postoperative 1 and 4 weeks. The eyelid hygiene group (n = 36) showed decreased SPEED score after cataract surgery and the control group (n = 33) did not. Anterior blepharitis grade was worse 1 week after surgery in the control group but not in the eyelid hygiene group. The control group had significantly decreased meibum quality and quantity in both the upper and lower eyelids after cataract surgery, but the eyelid hygiene group did not. Eyelid hygiene before/after cataract surgery improved postoperative subjective symptoms and prevented postoperative exacerbation of anterior blepharitis and MGD. Thus, perioperative eyelid hygiene is recommended for patients with obstructive MGD who undergo cataract surgery.