Correlación entre especies del género Demodex en chalaziones primarios y recurrentes / Correlation between Demodex species in primary and recurrent chalazia

Objetivo: Determinar la correlación entre la infestación por especies de Demodex y la ocurrencia de chalaziones primarios y recurrentes. Métodos: Estudio prospectivo y observacional. Se incluyeron pacientes con chalaziones primarios o recurrentes. Se tomó muestra de pestañas para determinar la presencia microscópica de Demodex spp. Se determinó la correlación entre la recurrencia del chalazión y la infestación por ácaros Demodex spp. mediante la prueba del coeficiente de correlación de rangos de Spearman. Resultados: Se incluyeron 68 pacientes adultos con diagnóstico de chalazión. En 63,2% del total de los casos se documentó la presencia de uno o más parásitos del género Demodex spp. En el estudio parasitológico cuantitativo se encontró que el 25% de todos los casos presentó infestación por Demodex spp. definida por un índice superior o igual a 0,5 parásitos por pestaña. La especie más frecuentemente encontrada fue Demodex folliculorum. De los 14 pacientes con chalazión recurrente el 50% presentó infestación por Demodex spp. y en el 91,7% de los casos la infestación fue por Demodex folliculorum. Existe una correlación positiva y directamente proporcional de (rø=+0,665; p<0,05) entre estos factores. De los pacientes con chalazión primario, solo 18,5% presentaron infestación por Demodex spp., y en el 81,6% de ellos fue causada por Demodex folliculorum. No existe una correlación significativa entre estos factores. Conclusión: Existe una correlación directa, alta y estadísticamente significativa entre la recurrencia del chalazión y la infestación por Demodex spp., no existe una correlación estadísticamente significativa entre los chalaziones primarios y la presencia de Demodex spp.(AU)

Objective: To determine the correlation between the infestation by species of Demodex spp. and the occurrence of primary and recurrent chalazia. Methods: Prospective and observational study. Patients with primary or recurrent chalazia were included. Eyelash samples were taken to determine the microscopic presence of Demodex spp. The correlation between the recurrence of the chalazia and the infestation by Demodex spp. mites was determined using Spearman's rank correlation coefficient test. Results: Sixty-eight adult patients diagnosed with chalazia were included. In 63.2% of the total cases, the presence of one or more parasites of the genus Demodex spp. was documented. In the quantitative parasitological study, it was found that 25% of all cases presented infestation by Demodex spp. defined by an index greater than or equal to 0.5 parasites per eyelash. The most frequently found species was Demodex folliculorum. Of the 14 patients with recurrent chalazia, 50% presented infestation by Demodex spp. and in 91.7% of the cases the infestation was by D. folliculorum. There is a positive, directly proportional correlation between these factors (rθ=+0.665, P<.05). In the group of patients with primary chalazion, only 18.5% presented infestation by Demodex spp., and in 81.6% of these cases it was caused by D. folliculorum. There is a non-statistically significant correlation between these two factors. Conclusion: There is a direct, high and statistically significant correlation between the recurrence of the chalazion and the infestation by Demodex spp., there is no statistically significant correlation between the primary chalazia and the presence of Demodex spp.(AU)

Correlation between Demodex species in primary and recurrent chalazia.

OBJECTIVE: To determine the correlation between the infestation by species of Demodex spp. and the occurrence of primary and recurrent chalazia. METHODS: Prospective and observational study. Patients with primary or recurrent chalazia were included. Eyelash samples were taken to determine the microscopic presence of Demodex spp. The correlation between the recurrence of the chalazia and the infestation by Demodex spp. mites was determined using Spearman's rank correlation coefficient test. RESULTS: Sixty-eight adult patients diagnosed with chalazia were included. In 63.2% of the total cases, the presence of one or more parasites of the genus Demodex spp. was documented. In the quantitative parasitological study, it was found that 25% of all cases presented infestation by Demodex spp. defined by an index greater than or equal to 0.5 parasites per eyelash. The most frequently found species was Demodex folliculorum. Of the 14 patients with recurrent chalazia, 50% presented infestation by Demodex spp. and in 91.7% of the cases the infestation was by D. folliculorum. There is a positive, directly proportional correlation between these factors (rθ=+0.665, P<.05). In the group of patients with primary chalazion, only 18.5% presented infestation by Demodex spp., and in 81.6% of these cases it was caused by D. folliculorum. There is a non-statistically significant correlation between these two factors. CONCLUSION: There is a direct, high and statistically significant correlation between the recurrence of the chalazion and the infestation by Demodex spp., there is no statistically significant correlation between the primary chalazia and the presence of Demodex spp.

Prevalence of Demodex spp. in patients with chronic blepharitis.

Blepharitis is a very common disease in ophthalmology, dermatology and allergy practice. It generally follows a chronic course and is frequently associated with objective and/or subjective symptoms such as epiphora, red eye, dandruff, gritty sensation, itching, burning, photophobia, and blurred vision. The purpose of this study is to analyze the prevalence of Demodex spp. in patients with symptoms of chronic blepharitis. An analytical cross-sectional study was conducted in the period between 2016 and 2020. All patients with symptoms of chronic blepharitis who underwent a parasitological test of eyelashes (Rapitest) in the Dermatology Department of the Hospital Italiano de Buenos Aires were included. Those with previously established blepharitis due to another infectious cause were excluded. We analyzed 972 patients. Sixty percent (n=585) underwent a positive Rapitest for the presence of Demodex spp. Seventy five percent (n=728) were women. There were no significant differences in the prevalence associated with sex (p=0.38). Among the patients positive for Demodex spp., 65% (n=628) were older than 60 years old. The most frequently associated symptom was itching, present in 35% (n=342). A statistically significant decrease in the number of consultations was observed during the cold months of the year (May-June-July-August). Our results show a high prevalence of Demodex spp. in patients with chronic blepharitis. As its presence reveals a direct association with age, we recommend looking for this parasite in this age group.

Evaluación in vitro de múltiples agentes antibacterianos para el tratamiento de la blefaritis anterior crónica estafilocócica / In vitro evaluation of multiple antibacterial agents for the treatment of chronic staphylococcal anterior blepharitis

Objetivo Evaluar la eficacia bactericida de varios compuestos utilizados en el tratamiento de la blefaritis anterior estafilocócica crónica mediante un estudio in vitro. Materiales y métodos Se cultivaron cepas comerciales estándar de Staphylococcus aureus (SAu) (ATCC 25923 Culti-Loops) y Staphylococcus coagulasa-negativo (CoNS) (ATCC 12228 Culti-Loops). Se realizaron pruebas de sensibilidad a vancomicina 30μg, netilmicina 30μg, ácido hipocloroso (HOCl) al 0,01% (Ocudox™, Brill®), aceite de hoja de Melaleuca alternifolia (MeAl) (Navyblef® Cuidado diario, NOVAX®) y digluconato de clorhexidina al 1% (DGCH) (Cristalmina™, Salvat®) mediante el método de difusión en disco de agar (Rosco Neo-Sensitabs™). A las 24horas se midieron los halos inducidos con calibradores automáticos. Los resultados se analizaron con las guías EUCAST- y CLSI potency Neo-Sensitabs™. Resultados La vancomicina indujo un halo de 22,37mm y 21,81mm en SAu y CoNS, respectivamente. La netilmicina produjo halos de 24,45mm en SAu y de 32,49mm en CoNS. MeAl indujo halos de 12,65mm en SAu y de 15,83mm en CoNS. Se encontró un halo de 12,11mm en SAu y un halo de 18,38mm en CoNS utilizando HOCl. DGCH produjo halos de 26,55mm y 23,12mm en SAu y CoNS, respectivamente. Conclusión La netilmicina y la vancomicina demostraron actividad antibiótica frente a ambos patógenos, por lo que pueden ser terapias alternativas de rescate para tratar la blefaritis estafilocócica crónica. El DGCH presenta una eficacia frente a ambos comparable a los antibióticos, mientras que el HOCl y la MeAl demuestran menor eficacia (AU)

Objective To evaluate the bactericidal efficacy of several compounds used in the treatment of chronic staphylococcal anterior blepharitis through an in vitro study. Materials and methods Standard commercial strains of Staphylococcus aureus (SAu) (ATCC 25923 Culti-Loops) and coagulase-negative Staphylococcus (CoNS) (ATCC 12228 Culti-Loops) were cultured. Susceptibility tests were performed to vancomycin 30μg, netilmicin 30μg, hypochlorous acid (HOCl) 0.01% (Ocudox™, Brill®), Melaleuca alternifolia leaf oil (MeAl) (Navyblef® Daily Care, NOVAX®) and 1% chlorhexidine digluconate (DGCH) (Cristalmina™, Salvat®) using the agar disk diffusion method (Rosco Neo-Sensitabs®). After 24hours, the induced halos were measured with automatic calipers. The results were analyzed using the EUCAST- and CLSI potency Neo-Sensitabs® guidelines. Results Vancomycin induced a halo of 22.37mm and 21.81mm in SAu and CoNS, respectively. Netilmicin produced halos of 24.45mm in SAu and 32.49mm in CoNS. MeAl induced halos of 12.65mm in SAu and 15.83mm in CoNS. A 12.11mm halo was found in SAu and an 18.38mm halo in CoNS using HOCl. DGCH produced halos of 26.55mm and 23.12mm in SAu and CoNS, respectively. Conclusion Netilmicin and vancomycin demonstrated antibiotic activity against both pathogens, so they can be alternative rescue therapies to treat chronic staphylococcal blepharitis. DGCH has efficacy against both comparable to antibiotics, while HOCl and MeAl show less efficacy (AU)

In vitro evaluation of multiple antibacterial agents for the treatment of chronic staphylococcal anterior blepharitis.

OBJECTIVE: To evaluate the bactericidal efficacy of several compounds used in the treatment of chronic staphylococcal anterior blepharitis through an in vitro study. MATERIALS AND METHODS: Standard commercial strains of Staphylococcus aureus (SAu) (ATCC 25923 Culti-Loops) and coagulase-negative Staphylococcus (CoNS) (ATCC 12228 Culti-Loops) were cultured. Susceptibility tests were performed to vancomycin 30 µg, netilmicin 30 µg, hypochlorous acid (HOCl) 0.01% (Ocudox™, Brill®), Melaleuca alternifolia leaf oil (MeAl) (Navyblef® Daily Care, NOVAX®) and 1% chlorhexidine digluconate (DGCH) (Cristalmina™, Salvat®) using the agar disk diffusion method (Rosco Neo-Sensitabs®). After 24 h, the induced halos were measured with automatic calipers. The results were analyzed using the EUCAST- and CLSI potency Neo-Sensitabs® guidelines. RESULTS: Vancomycin induced a halo of 22.37 mm and 21.81 mm in SAu and CoNS, respectively. Netilmicin produced halos of 24.45 mm in SAu and 32.49 mm in CoNS. MeAl induced halos of 12.65 mm in SAu and 15.83 mm in CoNS. A 12.11 mm halo was found in SAu and an 18.38 mm halo in CoNS using HOCl. DGCH produced halos of 26.55 mm and 23.12 mm in SAu and CoNS, respectively. CONCLUSION: Netilmicin and vancomycin demonstrated antibiotic activity against both pathogens, so they can be alternative rescue therapies to treat chronic staphylococcal blepharitis. DGCH has efficacy against both comparable to antibiotics, while HOCl and MeAl show less efficacy.

Ivermectina para Demodex folliculorum / Ivermectin for Demodex folliculorum

Objetivo: Evaluar el efecto de la ivermectina sobre Demodex folliculorum in vitro. Materiales y métodos: Bajo microscopio de luz se evaluó el movimiento y anatomía de los parásitos durante 90 minutos. En una lámina portaobjetos no se aplicó nada y sirvió como control. En las otras láminas se aplicó ivermectina al 0.6 y 1%, respectivamente. Resultados: Los parásitos en la placa de control no presentaron cambios en su movilidad ni en su estructura anatómica. Los parásitos a los que se les aplicó ivermectina en concentraciones de 0.6% presentaron alteraciones de movilidad y estructura después del minuto 30 y aquellos sometidos a la concentración al 1% presentaron alteraciones de movilidad y estructura después del minuto 15. Conclusiones: Nuestro estudio demuestra que la ivermectina al 0.6 y 1% afecta la estructura y función de Demodex folliculorum in vitro.

Objective: To evaluate the effect of Ivermectin on Demodex folliculorum in vitro. Materials and methods: Under a light microscope, the movement and anatomy of parasites was evaluated during 90 minutes. On one plate nothing was applied and served as a control. In the other two plates, ivermectin was applied at 0.6% and 1%, respectively. Results: The parasites on the control plate showed no changes in their mobility or anatomical structure. The parasites to which ivermectin was applied in concentrations of 0.6% presented alterations of mobility and structure after the 30th minute and those subjected to the 1% concentration presented alterations of mobility and structure after the 15th minute. Conclusions: Our study shows that ivermectin at 0.6 and 1% affects the structure and function of Demodex folliculorum in vitro.

Caracterización clínica de pacientes con blefaritis y demodecosis / Clinical characterization of patient with blefaritis and demodecosis

RESUMEN Fundamento: la blefaritis es una enfermedad común en la práctica oftalmológica, de curso crónico con crisis de exacerbación y causa multifactorial, a menudo se le asocia a Demodex spp., ácaro del folículo piloso, parásito extendido y frecuente; su infestación en humano se conoce como demodecosis. Objetivo: caracterizar desde el punto de vista clínico a pacientes con blefaritis y demodecosis. Métodos: se realizó un estudio descriptivo, transversal, en el Hospital Militar Clínico Quirúrgico Docente Dr. Octavio de la Concepción y de la Pedraja de la provincia Camagüey desde septiembre de 2017 a noviembre de 2018. La población objeto de estudio quedó conformada por 84 pacientes con diagnóstico de blefaritis en quienes se confirmó presencia de Demodex spp. que cumplieron criterios definidos por el autor. Se estudiaron variables biológicas (edad y sexo), clínica (síntomas y signos). Los resultados se expusieron en tablas, se utilizó estadística descriptiva para distribuciones de frecuencias. Se respetaron aspectos éticos para investigación en humanos. Resultados: en más de la mitad de los pacientes con diagnóstico de blefaritis se confirmó la presencia de Demodex spp., predominó los enfermos mayores de 61 años, así como del sexo femenino, las manifestaciones clínicas con mayor incidencia fueron: presencia de caspa cilíndrica, alteraciones de las pestaña, escozor y prurito, seguidos por inestabilidad de la película lagrimal, alteraciones de bordes palpebrales, queratitis superficial y sensación de cuerpo extraño. Conclusiones: el estudio demostró la presencia del Demodex spp. en un importante número pacientes con blefaritis lo que contrasta que, en Cuba no existe suficiente literatura documentada que muestre su prevalencia, comportamiento o técnicas diagnósticas, así como variantes terapéuticas eficientes en esta enfermedad.

ABSTRACT Background: the blepharitis is a common illness in the ophthalmological practice, of chronic course with exacerbation crisis and multifactorial etiology, often associated with Demodex spp., mite of the hair follicle, extended and frequent parasite; its infestation in human is known as demodecosis. Objective: to characterize from the clinical point of view patients with blepharitis and demodecosis. Methods: a descriptive, traverse study was carried out in the Educational Surgical Clinical Military Hospital Dr. Octavio of the Concepción and of the Pedraja of Camagüey in the period of September, 2017 to November, 2018. The population study object was conformed by 84 patients with diagnostic of blepharitis who were confirmed with the presence of Demodex spp. and they completed criteria defined by the author. Biological variables were studied (age and sex) and clinic (symptoms and signs). The results were exposed in charts using descriptive statistic for distributions of frequencies. Ethical aspects for investigation in human were respected. Results: in more than half of the patients with diagnostic of blepharitis was confirmed the presence of Demodex spp., the sick persons older than 61 years prevailed, as well as of the feminine sex, the clinical manifestations with more incidence were: presence of cylindrical dandruff, alterations of the lash, smarting and pruritus, continued by uncertainty of the lachrymal movie, alterations palpebral embroider, superficial keratitis and sensation of strange corpse in the eye. Conclusions: the study demonstrates the presence of the Demodex spp. in an important number patient with blepharitis which contrasts with, in Cuba there isn´t enough documented literature that shows their prevalence, behavior or diagnostic techniques, as well as efficient therapeutic variants in this illness.

Prevalence of Demodex spp. in eyelashes of a university's population in Santiago, Chile. / Prevalencia de Demodex spp. en pestañas de una población universitaria en Santiago, Chile.

OBJECTIVE: To determine the presence of Demodex spp. in the eyelashes' pilosebaceous unit in volunteers of one campus of a private university. MATERIALS AND METHODS: The volunteers underwent anamnesis, biomicroscopic study and samples were taken of 8 eyelashes, 2 of each eyelid of both eyes. The eyelashes were mounted on a slide and observed under a light microscope to determine the presence and quantity of mites. RESULTS: 200 volunteers were recruited, determining the prevalence of Demodex spp. in 54 (27%) of them. Of the positive cases, 40 (74.1%) presented signs and/or symptoms of blepharitis, 43 (79.7%) presented the mite in one eye and an average infestation rate of 0.65 Demodex spp. per eyelash was obtained. CONCLUSIONS: Approximately one in four of the volunteers studied without a diagnosis of blepharitis was a carrier of the parasite, of which a significant percentage presented some type of sign and/or symptom of this pathology which was related to a higher rate of infestation (p<0.05).

A prototype of a low-cost eyelid cleaning foaming solution for symptom management in patients with chronic blepharitis: An I-optimal mixture experimental design / Un prototipo de solución espumante de bajo costo para la limpieza de párpados y el manejo de síntomas en pacientes con blefaritis crónica: un diseño de mezcla I-óptimo

SUMMARY Blepharitis is a common chronic eye condition that causes eyelid inflammation, leading to inflamed, irritated, sticky and itchy eyelids and flaking of the skin. For its treatment, patients often need indefinite use of an eyelid cleaning solution which usually cost more than 20 USD per 80 ml bottle and lasts, on average, one month. For those patients unable to afford the treatment, physicians recommend the use of a do it yourself (DIY) solution. However, the efficacy of DIY eyelid solutions might fluctuate according to the type of blepharitis present in the patient and inadequate pH stabilization of the solution might promote additional itchiness, irritation, and dryness of the skin and eyes. Thus, we propose an optimized DIY solution prototype for symptom management in patients with chronic blepharitis. The formulation contains a significant ratio of tea tree oil and resulted in suitable pH and foam expansion values. The low cost and ease of preparation of the designed formulation make it an affordable, effective alternative in the treatment of chronic blepharitis.

RESUMEN La blefaritis crónica es una condición ocular que causa inflamación en los párpados, dando como resultado párpados irritados, pegadizos y descamación de la piel. Pacientes con esta condición necesitan usualmente de la aplicación de una solución de limpieza de párpados que cuesta en promedio 20 USD por cada 80 ml de solución y tiene un rendimiento de un mes. Para aquellos pacientes incapaces de costear el tratamiento, los médicos recomiendan el uso de soluciones hazlo tú mismo (DIY en inglés). Sin embargo, la eficacia de estas en el tratamiento de la condición puede fluctuar de acuerdo con el tipo de blefaritis presente. Adicionalmente, una inadecuada estabilización del pH de la solución puede promover una mayor irritación, resequedad y picazón en la piel y en los ojos. Por lo tanto, en este trabajo proponemos un prototipo experimental de solución DIY para el manejo sintomático de pacientes con blefaritis crónica. La formulación contiene una proporción significativa de aceite de árbol de té y posee un pH adecuado y alta producción de espuma para su correcta aplicación en la piel. El bajo costo y facilidad de preparación hacen de ella una alternativa efectiva y asequible en el tratamiento de la blefaritis crónica.

Ocular demodicosis: A review. / Demodicosis ocular: una revisión.

Demodex folliculorum and Demodex brevis are ectoparasites that inhabit the skin of humans. They have been related to alterations in the ocular surface, such as, dysfunction of Meibomian glands, blepharitis, chalazion, etc. Ocular demodicosis is characterised by the pathognomonic presence of cylindrical dandruff at the base of the eyelashes, and various symptoms including, among others, itching, lacrimation, and hyperaemia. A bibliographic review was carried out on the role of Demodex spp. in ocular disease, including publications made by the scientific society between 2005 and 2018. A significant relationship was found between prevalence and incidence of Demodex spp. in eye diseases. D. folliculorum is usually found more frequently than D. brevis in ocular infestation, with the prevalence or incidence of infestation by both species increasing with the age of the patient. In patients with blepharitis or other infectious diseases of the ocular surface, unresolved with antibacterial treatment, the search for Demodex spp. should be considered.

Ácaros del género Demodex: ¿parásitos colonizadores de personas sanas o asociados a patología ocular? / Demodex genus: colonizing parasites of healthy people or mites associated with ocular pathology?

Las especies Demodex folliculorum y Demodexbrevis, responsables de la demodicosis humana, afectan la piel y en ocasiones están vinculadas con afecciones oculares. El objetivo de este trabajo fue conocer si existe asociación significativa entre la presencia del ácaro y de patologías palpebrales, y el papel de factores como la edad y el sexo de los pacientes. Se analizaron las pestanas de un conjunto de pacientes sintomáticos y asintomáticos (n = 72) de entre 9 y 82 años. El 53% de los pacientes fueron positivos para la presencia del ácaro Demodex. De ellos, el 66% manifestó síntomas o patologías oculares, dentro de las cuales la blefaritis y el ojo seco resultaron prevalentes. Se observaron asociaciones significativas tanto entre la presencia de este ácaro y una edad mayor de 60 años (p < 0,001), como entre la presencia del ácaro y ojo seco o blefaritis o ambos (p <0,001). Consideramos necesaria la búsqueda de Demodex sp. en pacientes con síndrome de ojo seco o blefaritis, especialmente durante la inmunosenescencia, a fin de instaurar tratamientos antiparasitarios específicos.

Demodex folliculorum and Demodex brevis are mites that are responsible for human demodicosis affecting skin and frequently linked to ocular diseasess. The aim of this work was to determine the association between Demodex sp. and eyelid and eyelash diseases and to establish the predisposing factors for acquiring this parasitic disease. Eyelashes from symptomatic and asymptomatic patients (n = 72) between 9 and 82 years old were analyzed, where 53% were positive for Demodex sp., of which 66% manifested ocular symptoms and pathologies, blepharitis and dry eye being prevalent. Significant correlations between Demodex and patients over 60 years of age (p <0.001) and between Demodex sp. and dry eye patients / blepharitis (p <0.001) were observed. We consider that it is necessary to search for Demodex sp. especially in those patients suffering from dry eye and blepharitis and/or during immunosenescence in order to implement specific antiparasitic treatments.

Relationship between blepharitis and components of the metabolic syndrome. / Relación entre blefaritis y componentes del síndrome metabólico.

OBJECTIVE: To determine the relationship between the components of the metabolic syndrome with the presence of blepharitis. METHODS: The study included 60 patients with a diagnosis of blepharitis and 30 control subjects. Anthropometric measurements and blood pressure were recorded, and peripheral venous blood samples were obtained under fasting conditions to determine the concentration of Glucose, Cholesterol, and Triglycerides. High-density lipoprotein cholesterol (HDL-C) was determined after precipitating lipoproteins containing apoB-100 with phosphotungstic acid/Mg2+. The concentration of low density lipoprotein cholesterol (LDL-C) was calculated using the Friedewald formula modified by DeLong. RESULTS: In the comparative analysis, statistically significant differences were found in the waist circumference (P=.0491), systolic blood pressure (P=.0149), glucose (P=.0045), total cholesterol (P=.0001), HDL-C (P=.0049), LDL-C (P=.0266), and triglycerides (P=.0059); while there was no significant differences in the BMI or the diastolic pressure. CONCLUSIONS: The results support the hypothesis that the metabolic syndrome could be considered a risk factor for the development of blepharitis, and its timely detection is essential to avoid future complications.

Eyelid tinea with blepharitis due to Microsporum canis. / Tiña palpebral con blefaritis por Microsporum canis.

CASE REPORT: The case is presented of a 3-year-old girl with an erythematous oedematous plaque associated with blepharitis, and chalazion in the right upper eyelid. She received empirical treatment with topical corticosteroids, as well as an antifungal and antibiotic, without observing any improvement. The culture of the eyelid scrape showed Microsporum canis. Therefore, she was prescribed oral terbinafine and topical miconazole-betamethasone, achieving a clinical and microbiological recovery. DISCUSSION: Eyelid infection due to dermatophytes is uncommon, but it should be considered among the diagnostic suspicions of palpebral skin lesions. The microbiological study is a key factor for its diagnosis and appropriate treatment.

[Demodex genus: colonizing parasites of healthy people or mites associated with ocular pathology?] / Ácaros del género Demodex: ¿parásitos colonizadores de personas sanas o asociados a patología ocular?

Demodex folliculorum and Demodex brevis are mites that are responsible for human demodicosis affecting skin and frequently linked to ocular diseasess. The aim of this work was to determine the association between Demodex sp. and eyelid and eyelash diseases and to establish the predisposing factors for acquiring this parasitic disease. Eyelashes from symptomatic and asymptomatic patients (n=72) between 9 and 82 years old were analyzed, where 53% were positive for Demodex sp., of which 66% manifested ocular symptoms and pathologies, blepharitis and dry eye being prevalent. Significant correlations between Demodex and patients over 60 years of age (p<0.001) and between Demodex sp. and dry eye patients / blepharitis (p<0.001) were observed. We consider that it is necessary to search for Demodex sp. especially in those patients suffering from dry eye and blepharitis and/or during immunosenescence in order to implement specific antiparasitic treatments.

DERMATITIS PALPEBRAL

La dermatitis palpebral constituye un proceso inflamatorio frecuente, ya que la piel que recubre los párpados es especialmente susceptible a la acción de agentes irritantes y alergénicos. La piel de ésta región es cuatro veces más fina que en el resto de la cara, lo que facilita la aparición de edema en caso de inflamación. Otros factores que influyen son la función anormal de la barrera cutánea que puede promover el desarrollo de la sensibilización, y el fácil acceso de numerosos alergenos a dicha zona, los que pueden llegar por contacto directo con las manos, por vía aerotransportada y en menor medida por aproximación. Son múltiples las causas que pueden originar dermatitis palpebral, tanto puramente dermatológicas como sistémicas, siendo en algunas ocasiones multifactorial. De todas ellas la más frecuente es la dermatitis alérgica por contacto, y en menor medida la dermatitis atópica y dermatitis irritativa por contacto También pueden verse comprometidos con un estado inflamatorio crónico los bordes palpebrales, lo que se denomina blefaritis. Los pacientes pueden referir dolor, ardor, prurito y sensación de cuerpo extraño. En ocasiones, debido a la variedad de patologías que pueden producir dermatitis palpebral, el diagnóstico diferencial suele ser difícil de realizar. Es importante conocer el factor causal para poder realizar un tratamiento adecuado, ya que al ser un trastorno por lo general persistente, los pacientes a menudo se someten a terapias inadecuadas, sin obtener la curación del cuadro.

Palpebral dermatitis is a frequent inflammatory process, since the skin covering the eyelids is especially susceptible to the action of irritants and allergens. The skin of this region is four times thinner than in the rest of the face, which facilitates the appearance of edema in case of inflammation. Other factors that influence are the abnormal function of the cutaneous barrier that can promote the development of sensitization, and the easy access of numerous allergens to this area, which can come by direct contact with the hands, by airborne and to a lesser extent by approximation. There are many causes that can cause palpebral dermatitis, both purely dermatological and systemic, being sometimes multifactorial. Of all of them, the most frequent is allergic contact dermatitis, and to a lesser extent, atopic dermatitis and irritant contact dermatitis. The palpebral borders can also be compromised with a chronic inflammatory state, which is called blepharitis. Patients may report pain, burning, pruritus and foreign body sensation. Occasionally, due to the variety of pathologies that can produce palpebral dermatitis, the differential diagnosis is usually difficult to perform. It is important to know the causal factor to be able to perform an adequate treatment, since being a generally persistent disorder, patients often undergo inadequate therapies, without obtaining the cure of the pathology.

High prevalence of Demodex spp. infestation among patients with posterior blepharitis: correlation with age and cylindrical dandruff. / Alta prevalencia de infestación por Demodex spp. en pacientes con blefaritis posterior: correlación con edad y caspa cilíndrica.

OBJECTIVE: To determine prevalence of Demodex spp. and infestation index (II) by the parasite among patients of different ages with blepharitis and to assess association with occurrence of cylindrical dandruff (CC). MATERIALS AND METHODS: Prospective study including patients diagnosed with posterior blepharitis between 2013 and 2015, without previous acaricide treatment, was conducted by Fundación Oftalmológica Los Andes (Chile). Four eyelashes were randomly extracted from each eyelid for parasite detection. The II was calculated as the ratio between the total number of demodex specimens found in the total number of eyelashes removed. A semi-quantitative determination of the CC was performed. RESULTS: A total of 178 patients (91 men, 87 women), with a mean age of 58.49±20.66 years, were included. It was found that 83.7% of patients were infested with Demodex folliculorum with a mean II of 0.96±0.84 mites/eyelash. The II was significantly higher in patients over 50 years (p<.0001). Patient age and II showed a Pearson correlation coefficient (R2) of 0.12 (p<.0001). CC was observed in 71.4% of patients, with those over 50 years-old showing significantly higher values. A positive correlation was also observed between the amount of CC and the II (R2=.33; p<.0001). CONCLUSIONS: The prevalence of infestation by Demodex folliculorum is high in patients with posterior blepharitis. The II by the parasite is positively correlated with age and with the occurrence of CC on the eyelid border.

Topical tacrolimus 0.03% for the treatment of ocular psoriasis. / Tacrolimus tópico al 0,03% en el tratamiento de la psoriasis ocular.

OBJECTIVE/METHODS: Cases are presented of 4 patients suffering from severe symptoms due to ocular psoriasis and who were treated with off-label 0.03% tacrolimus once a day. RESULTS/CONCLUSIONS: All four patients had a mixed blepharitis and keratitis. Pseudopterygium and corneal opacities were present in three of them. All of them experienced an improvement of their itching and ocular surface. They all referred to a marked improvement of their quality of life in a follow-up period ranging from six months to two years. Therefore, topical tacrolimus could be considered an option in the treatment of ocular psoriasis.

Complicaciones de la Blefaritis. Presentación de caso / Complications of Blepharitis. Case presentation

Introducción: la Blefaritis se define como inflamación bilateral crónica de los bordes palpebrales. Produce alteraciones de bordes palpebrales, glándulas de Meibomio, córnea, conjuntiva y película lagrimal, dando lugar a complicaciones. Tiene especial importancia debido a su elevada incidencia y al daño que produce sobre la superficie ocular. Objetivo: evidenciar manifestaciones clínicas y complicaciones oftalmológicas en paciente con Blefaritis mixta. Presentación del caso: paciente masculino de 82 años, raza negra con antecedentes patológicos personales de salud, acude por aumento de volumen del párpado inferior de ojo izquierdo desde hace 2 años acompañado de secreción y lagrimeo, sin tratamiento previo. El examen oftalmológico evidencia párpado inferior invertido, pestañas que contactan con la conjuntiva. Bordes palpebrales inflamados, con costras y telangiectasias, dilatación de los orificios de las glándulas de Meibomio. Lesiones tumorales en número de 3 que varían entre 2 y 4 mm, duras e indoloras en tarso inferior. Inyección conjuntival moderada y secreción espumosa. Prueba de Shirmer I 9 mm y tiempo de ruptura de película lagrimal 5 segundos. Se diagnosticó Blefaritis mixta complicada con múltiples chalazión, entropión y queratoconjuntivitis seca. Se indicó, previo consentimiento del paciente, tratamiento con tetraciclina, prednisolona, lágrimas artificiales y tratamiento quirúrgico de múltiples chalazión, y se logró la desaparición del entropión. Se realizó el diagnóstico diferencial con carcinoma de glándulas sebáceas, penfigoide cicatrizal y síndrome de Stevens-Johnson. Conclusiones: la Blefaritis es causa importante de morbilidad ocular debido a los cambios que ocasiona sobre la anatomía de los párpados y película lagrimal con el consecuente daño a la superficie ocular(AU)

Introduction: the Blepharitis is defined like a chronic inflammation of the eyelids borders. It produces alterations of eyelids borders, Meibomio glands, and cornea, conjunctive and lachrymal film, giving place to complications. It has special importance due to their high incidence. Objective: evidencing clinical manifestations and ophthalmologic complications in patient with mixed Blepharitis. Case Presentation: a male patient of 82 years, black race with antecedents of health consults because an increase of volume of the lower left lid of eye for 2 years accompanied by secretion and shed tears, without previously treatment. The ophthalmologic exam evidences reversed lower lid, lashes that contact with the conjunctive. We observed a palpable border with a blush eyelid and scabs, telangiectasias, dilation of the holes of Meibomio glands, tumor injuries in number of 3 with a size between 2 and 4 mm, hard and painless lower plate, moderate conjunctival injection, and scarce foamy secretion. The Schirmers test I 9 mm and plate break down up to 5 seconds. It was diagnosed complicated mixed Blepharitis with multiple chalazion, entropion and dry keratoconjunctivitis. Previous informed consent treatment was indicated withtetracycline, prednisolone, artificial tears and surgical treatment of multiple chalazion, being achieved the disappearance of the entropion. It was carried out the differential diagnosis with carcinoma of sebaceous glands, cicatricial pemphigus and Stevens-Johnson´s syndrome. Conclusions: the Blepharitis is an important cause of ocular morbidity due to the changes produced on the anatomy of the lids and lachrymal film with the consequent damage to the ocular surface(AU)

Demodex spp en pacientes con blefaritis crónica / Demodex spp in chronic blepharitis patients

Background: Blepharitis is a very common disease in the ophthalmologic practice generally taking a chronic course with intermittent exacerbations. Several studies have linked the presence of Demodex folliculorum with chronic blepharitis, since the mite has the capacity to perpetuate the follicular inflammatory process. The prevalence of infection by Demodex spp. is variable depending on the population. In Paraguay, information on the frequency of the infestation in patients with chronic blepharitis is not available. Aim : To determine the frequency of Demodex spp, and the ocular microbiota in patients with chronic blepharitis attending the Department of Ophthalmology at the Teaching Hospital of the National University of Asuncion. Patients and Methods: Consecutively, 28 patients with chronic blepharitis, who agreed to participate in the study, were included. Eyes lashes from the upper and lower eyelids were extracted for immediate mite search by direct observation under a light microscope. Samples from eyelids were taken with Kimura spatula and then cultured on blood agar and in enrichment media and incubated in 5% CO2 at 35° C for 72 hours. Results: Among participants, females were more frequent (64%), the age ranged from 17 to 87 years (mean: 38.0; SD: ±13.5 years). The prevalence of Demodex sp was 54%. Bacteria were isolated 92.9% of cases, most frequently coagulase-negative staphylococci (75%). No association was found between socio-demographic or clinical characteristics and the presence of Demodex sp. Conclusion: The observed high prevalence of infestation by Demodex spp in patients with chronic blepharitis is consistent with other studies.

Introducción: La blefaritis es una enfermedad muy común en la práctica oftalmológica, generalmente de curso crónico con exacerbaciones intermitentes. Varios estudios han relacionado la presencia del Demodex folliculorum con la blefaritis crónica, por su capacidad potencial de perpetuar el proceso inflamatorio a nivel folicular. La frecuencia de D. folliculorum varía de acuerdo a la población. Objetivo: Determinar la presencia de Demodex spp y, caracterizar la microbiota ocular en pacientes con blefaritis crónica y dar a conocer estos resultados. Pacientes y Métodos: Las muestras fueron obtenidas de pacientes que consultaron en la Cátedra de Oftalmología del Hospital de Clínicas de la Universidad Nacional de Asunción (UNA). Fueron incluidos en forma consecutiva 28 pacientes con blefaritis crónica que accedieron a participar en forma voluntaria en el estudio. Se extrajeron las pestañas del párpado superior e inferior de los pacientes para la búsqueda inmediata del ácaro por observación directa bajo el microscopio óptico. Para el cultivo de microorganismos se tomaron muestras del párpado con espátula de Kimura, las que fueron cultivadas en agar sangre y en medios de enriquecimiento e incubadas en CO2 al 5% a 35°C durante 72 h. Resultados: El sexo femenino fue más frecuente (64%), el rango de edad estuvo entre 17 y 87 años con una media de 37,9 ± 13,5. Se observó la presencia de Demodex sp en 54% y aislamiento de bacterias en 92,9%; Staphylococcus coagulasa negativa fue el más frecuente (75%). No se encontraron asociaciones entre las características socio-demográficas o clínicas y la presencia de Demodex sp. Conclusión: La alta infestación por Demodex spp observada en los pacientes con blefaritis crónica coincide con otros estudios.