XdemvyTM (Lotilaner Ophthalmic Solution) 0.25% Topical Solution for the Treatment of Demodex Blepharitis.

XdemvyTM (lotilaner ophthalmic solution) 0.25% topical solution was recently approved for the treatment of Demodex blepharitis in adults aged ≥18 years. As an antiparasitic agent, lotilaner selectively inhibits gamma-aminobutyric acid chloride channels specific to the parasite and induces spastic paralysis, leading to death of Demodex blepharitis mites. In two randomized, double-masked, vehicle-controlled, multi-center, phase-3 clinical trials (Saturn-1 and Satuirn-2), lotilaner 0.25% topical solution was investigated for the treatment of Demodex blepharitis. Patients were assigned to receive either lotilaner 0.25% topical solution or vehicle (solution that did not contain lotilaner as an active ingredient) twice daily for 6 weeks. On day 43, lotilaner group demonstrated primary efficacy in achieving collarette cure ([collarette grade 0], Saturn-1: study group 44% [92/209], vehicle 7.4% [15/204]; Saturn-2: study group 56% [108/193], vehicle 12.5% [25/200]). Secondary efficacy was achieved by eradication of mite ([0 mite/lash], Saturn-1: study group 67.9% [142/209], vehicle 17.6% [36/304]; Saturn-2: study group 51.8% [99/193], vehicle 14.6% [29/200]), composite cure ([grade 0 collarette as well as grade 0 erythema], Saturn-1: study group 13.9% [29/209], vehicle 1.0% [2/204]; Saturn-2: study group 19.2% [37/193], vehicle 4% [8/200]), and erythema cure ([grade 0 erythema], study group 19.1% [40/209], vehicle 6.9% [14/204]; Saturn-2: study group 31.1% [60/193], vehicle 9.0% [18/199]). The adverse events were mild, with the most common being pain at instillation site. The recommended regimen for lotilaner 0.25% solution is one drop in each eye twice daily for 6 weeks.

Prevalence of Demodex folliculorum and Demodex brevis in patients with blepharitis and chalazion.

PURPOSE: Demodex folliculorum and Demodex brevis are common ectoparasites on skin that also can lead to blepharitis and chalazion. The aim of our study is to determine the prevalence of Demodex spp. in eyelashes of patients diagnosed with chronic blepharitis and chalazion. METHODS: This study included 330 patients diagnosed with chronic blepharitis, 70 patients diagnosed with chalazion and 130 volunteers without any ocular problems. Patient eyelashes were examined under a light microscope at magnifications of × 40, × 100 and × 400. Demodex spp. were determined. RESULTS: Parasite prevalence was significantly higher in blepharitis (75.5%) and chalazion groups (70%) compared to the control group (16.2%) (p < 0.001). The prevalence of D. folliculorum in the blepharitis group and D. brevis in the chalazion group was found to be significantly higher compared to other groups (p < 0.05). The average number of mites per eyelash was found to be significantly higher in patients with Demodex positive blepharitis (p = 0.001) and in chalazion patients (p = 0.047) than in the control group. It has been determined that mite positivity increases with age in blepharitis and control groups (p < 0.05). In the group with blepharitis, it was found that mite positivity was significant in the presence of symptoms (p = 0.0001) and Demodex positivity decreased as the education level of individuals increased (p = 0.039). CONCLUSION: The results of the study show that Demodex spp infestations should be considered in chronic blepharitis and chalazion.

Efficacy of Topical Ivermectin 1% in the Treatment of Demodex Blepharitis.

PURPOSE: The purpose of this study was to evaluate the efficacy of topical ivermectin 1% cream application on the eyelashes in combination with eyelid hygiene in the treatment of Demodex blepharitis. METHODS: One hundred two eyes of 102 patients with symptomatic Demodex blepharitis were divided into 2 groups according to the use of topical ivermectin in this retrospective case-control study. The ivermectin group (n = 51) applied topical ivermectin 1% cream on the eyelashes for 15 minutes once weekly, but the control group (n = 51) did not. In both groups, eyelid hygiene was performed once daily. The Standard Patient Evaluation of Eye Dryness (SPEED) symptom questionnaire score, Oxford staining score, eyelid debris, eyelid redness/swelling, and telangiectasia were assessed during the follow-up visits. RESULTS: The mean follow-up periods of the ivermectin and control groups were 15.1 ± 9.7 weeks and 14.8 ± 8.6 weeks, respectively. The SPEED score and eyelid debris grade were significantly improved in both groups during the follow-up, although the SPEED score and eyelid debris grade showed greater changes in the ivermectin group than in the control group. The Oxford staining score, eyelid redness/swelling grade, and telangiectasia grade were significantly improved only in the ivermectin group but not in the control group. CONCLUSIONS: In patients with Demodex blepharitis, the use of topical ivermectin 1% cream for 15 minutes once weekly in addition to eyelid hygiene had more significantly improved symptoms, ocular surface staining, eyelid debris, redness/swelling, and telangiectasia as compared with eyelid hygiene alone. These findings support the efficacy of topical ivermectin 1% cream application in the treatment of Demodex blepharitis.

Effect of ocular demodicosis on the stability of the tear film and the tear break up time.

The aim of the study was to analyze the correlation between the presence of Demodex mites in the hair follicles of patients' eyelashes and the stability and break up time of the tear film assessed with the Non-Invasive Tear Break Up Times (NIBUT) method. 319 patients were included in the study (195 women, 124 men). The patients were divided into two groups: those with Demodex infestation and without visible symptoms of eyelid or eye surface diseases, and asymptomatic non-infested patients. The NIBUT analysis was performed with a 5 M keratograph (oculus). Non-invasive tests were performed to identify the first and mean values of the tear break up time. The first and mean tear break up time in the Demodex-infested group was lower than in the non-infested subjects. The difference was a highly statistically significant. There was a significant correlation with the age of the patients for the first break up time. The first break up time in both eyes decreased with the age of the Demodex-infested and non-infested patients. The NIBUT analyses indicate the impact of Demodex mites on the tear film stability. This may suggest possible association of demodicosis with dry eye syndrome.

Collarette Elimination and Demodex Mite Eradication with Topical Lotilaner Ophthalmic Solution, 0.25.

Purpose: To evaluate the efficacy of topical lotilaner ophthalmic solution, 0.25%, in patients with Demodex blepharitis. Methods: Eighteen adults with Demodex blepharitis, defined as >10 collarettes on the upper lid and/or mite density of ≥1.5 mites per lash (upper and lower), were treated bid for 42 days with the topical lotilaner ophthalmic solution, 0.25%. Contact lens wear, artificial eyelashes, and lid structural abnormalities were among the exclusion criteria. No other antibacterial, antiparasitic, or anti-inflammatory treatment or lid hygiene products were permitted. One eye of each patient was selected for analysis and assessed on day 7, 14, 28, and 42. Collarettes were graded at each visit, and mite density was evaluated by microscopy at each visit except day 7. Outcome measures were collarette elimination (≤2 lashes with collarettes) and mite eradication (0 mites). Drop tolerability, adverse events, visual acuity, and slit-lamp biomicroscopy were assessed. Results: Collarette elimination was achieved in 13/18 participants (72.2%) by day 42. Mean collarette grade (upper lid) declined from 3.56 ± 0.17 to 0.28 ± 0.11. Mite eradication was achieved in 14/18 participants (77.8%) by day 42. Mean mite density decreased from 2.63 ± 0.39 to 0.12 ± 0.08 mites/lash. Participants reported good tolerability. Adverse events were mild and transient and did not result in treatment discontinuation. Conclusion: Six weeks of at-home topical therapy with the lotilaner ophthalmic solution, 0.25%, was effective in eliminating the most common objective signs of Demodex blepharitis, with a collarette elimination rate of 72% and mite eradication in 78% of eyes by day 42. ISRCTN registration #: 24398865.

Corneal Effects of Tea Tree Oil.

PURPOSE: The purpose of this study is to report a case of corneal epithelial defects resulting from topical treatment of blepharitis with tea tree oil (TTO). METHODS: A 44-year-old man with a 1 year history of blepharitis non-responsive to eyelid hygiene was found to have signs of Demodex infestation. He was treated with a topical, off-label 50% TTO solution. Shortly afterward, the patient complained of bilateral ocular discomfort. RESULTS: Slit-lamp examination revealed conjunctival injection and a corneal epithelial defect in both eyes. Treatment with lubricant, antibiotic, and steroid eye drops as well as bandage contact lenses was required to facilitate corneal healing. CONCLUSIONS: Topical use of off-label, 50% concentration TTO can result in corneal epithelial defects. Eye care professionals should remain aware of this risk and only use approved, low-concentration TTO products when treating Demodex-related blepharitis.

Unilateral Phthiriasis Palpebrarum: A Case Study

Phthiriasis palpebrarum is a rare eyelid infestation caused by Phthirus pubis (pubic lice) that is often confused with other causes of blepharoconjunctivitis. In this study, we report the case of a 49-year-old male patient with phthiriasis palpebrarum who presented with itching and eye irritation in the left eye and had undergone treatment for conjunctivitis in the past month. Biomicroscopic examination revealed a dense population of motile and translucent lice and eggs, more intensely on the upper lid. For treatment, the lice were first cleaned mechanically, eyelashes were cut from the bottom, and eggs and lice were removed from the eye, after which petrolatum jelly (vsaseline) was applied to the lids for 10 days. In the control examination, no lice and eggs were observed.

Prevalence of Ocular Demodicosis in an Older Population and Its Association With Symptoms and Signs of Dry Eye.

PURPOSE: To evaluate associations between Demodex and its symptoms and ocular surface parameters in individuals with dry eye (DE). METHODS: A cross-sectional study of 119 individuals with DE symptoms or signs, grouped by the presence of ocular demodicosis, was performed. All individuals filled out questionnaires and underwent an ocular surface examination. Demographics, comorbidities, symptoms profiles, and ocular surface parameters were compared between the 2 groups. Multivariable regression analyses were used to determine which factors were associated with DE symptoms. Receiver operating curves analyses were performed to evaluate relationships between Demodex quantity and specific clinical phenotypes. RESULTS: Demodex was highly prevalent in our population (68.9%) with average counts of 4.2 ± 3.9. Individuals with and without Demodex had comparable demographics. Overall, symptoms profiles were similar between individuals with and without Demodex using the Dry Eye Questionnaire 5 and Ocular Surface Disease Index. Individuals with Demodex, however, were more likely to report itching (58.5% vs. 35.1%, P = 0.03), with increasing frequency in those with higher Demodex counts. Individuals with Demodex also had more severe eyelid abnormalities [cylindrical dandruff (CD) and lid vascularity] and a more unstable tear film but similar tear production and corneal staining when compared with individuals without Demodex. Neither Demodex nor ocular surface findings related to DE symptoms in multivariable analyses. Receiver operating curves analysis revealed Demodex counts ≥2 maximized sensitivity and specificity for both itching (64.7% and 59.0%, respectively) and CD (80.4% and 60.4%, respectively). CONCLUSIONS: Demodex is highly prevalent in an older population with DE. Symptom of itching and CD were the findings most specific for Demodex.

In which rosacea patients should Demodex in the eyelashes be investigated?

AIM: The aim of this study was to investigate the relationship between the presence of Demodex on the face and within the eyelash follicles in patients with rosacea. SUBJECTS AND METHODS: This prospective cross-sectional study included 80 participants, 40 patients with rosacea and 40 individuals with no rosacea as controls. The presence of Demodex on the face was assessed by standard superficial skin biopsy. Sixteen eyelashes were epilated from each patient and control. RESULTS: The rate of Demodex infestation and severe infestation on the face in patients with rosacea was significantly higher than the control group. Demodex count within the eyelash follicle was significantly higher in patients with erythematotelangiectatic type rosacea than the control group. There was no increase in blepharitis in rosacea patients but when blepharitis was present, the rate of the presence of Demodex was higher in this group. There was a statistically significant relationship between the presence of Demodex within the eyelashes and itchy eyes in people without blepharitis. CONCLUSION: When at least one Demodex is found on the face in rosacea patients, the eyelashes should be examined for effective treatment of the mite. Itchy eyes may be an important sign of the presence of Demodex in people without blepharitis.

Ocular Demodex: a systematic review of the clinical literature.

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.

Tea tree oil for Demodex blepharitis.

BACKGROUND: Demodex blepharitis is a chronic condition commonly associated with recalcitrant dry eye symptoms though many people with Demodex mites are asymptomatic. The primary cause of this condition in humans is two types of Demodex mites: Demodex folliculorum and Demodex brevis. There are varying reports of the prevalence of Demodex blepharitis among adults, and it affects both men and women equally. While Demodex mites are commonly treated with tea tree oil, the effectiveness of tea tree oil for treating Demodex blepharitis is not well documented. OBJECTIVES: To evaluate the effects of tea tree oil on ocular Demodex infestation in people with Demodex blepharitis. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 6); Ovid MEDLINE; Embase.com; PubMed; LILACS; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We used no date or language restrictions in the electronic search for trials. We last searched the databases on 18 June 2019. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that compared treatment with tea tree oil (or its components) versus another treatment or no treatment for people with Demodex blepharitis. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the titles and abstracts and then full text of records to determine their eligibility. The review authors independently extracted data and assessed risk of bias using Covidence. A third review author resolved any conflicts at all stages. MAIN RESULTS: We included six RCTs (1124 eyes of 562 participants; 17 to 281 participants per study) from the US, Korea, China, Australia, Ireland, and Turkey. The RCTs compared some formulation of tea tree oil to another treatment or no treatment. Included participants were both men and women, ranging from 39 to 55 years of age. All RCTs were assessed at unclear or high risk of bias in one or more domains. We also identified two RCTs that are ongoing or awaiting publications. Data from three RCTs that reported a short-term mean change in the number of Demodex mites per eight eyelashes contributed to a meta-analysis. We are uncertain about the mean reduction for the groups that received the tea tree oil intervention (mean difference [MD] 0.70, 95% confidence interval [CI] 0.24 to 1.16) at four to six weeks as compared to other interventions. Only one RCT reported data for long-term changes, which found that the group that received intense pulse light as the treatment had complete eradication of Demodex mites at three months. We graded the certainty of the evidence for this outcome as very low. Three RCTs reported no evidence of a difference for participant reported symptoms measured on the Ocular Surface Disease Index (OSDI) between the tea tree oil group and the group receiving other forms of intervention. Mean differences in these studies ranged from -10.54 (95% CI - 24.19, 3.11) to 3.40 (95% CI -0.70 7.50). We did not conduct a meta-analysis for this outcome given substantial statistical heterogeneity and graded the certainty of the evidence as low. One RCT provided information concerning visual acuity but did not provide sufficient data for between-group comparisons. The authors noted that mean habitual LogMAR visual acuity for all study participants improved post-treatment (mean LogMAR 1.16, standard deviation 0.26 at 4 weeks). We graded the certainty of evidence for this outcome as low. No RCTs provided data on mean change in number of cylindrical dandruff or the proportion of participants experiencing conjunctival injection or experiencing meibomian gland dysfunction. Three RCTs provided information on adverse events. One reported no adverse events. The other two described a total of six participants randomized to treatment with tea tree oil who experienced ocular irritation or discomfort that resolved with re-educating the patient on application techniques and continuing use of the tea tree oil. We graded the certainty of the evidence for this outcome as very low. AUTHORS' CONCLUSIONS: The current review suggests that there is uncertainty related to the effectiveness of 5% to 50% tea tree oil for the short-term treatment of Demodex blepharitis; however, if used, lower concentrations may be preferable in the eye care arena to avoid induced ocular irritation. Future studies should be better controlled, assess outcomes at long term (e.g. 10 to 12 weeks or beyond), account for patient compliance, and study the effects of different tea tree oil concentrations.

Blepharitis Caused by Demodex

Objective: Demodicosis is a Skin disease in humans caused by Demodex folliculorum (D. folliculorum) and Demodex brevis (D.brevis) mites. Demodex infestation is mostly located in sebaceous and meibomian glands in the hair follicles. The aim of this study was to determine the age and sex distribution of Demodex infestation in patients with blepharitis. Methods: Between 2011-2018, eyelashes from 335 patients with blepharitis, visual impairment or conjunctivitis attached to the cellophane tape were sent to the laboratory of Department of Medical Parasitology in Çukurova University Medical Faculty and were examined within 1 hour. Results: D. folliculorum was detected in 143 (42.6%) of the 335 patients. Of the patients in whom D. folliculorum was detected, 50 (35%) were female and 93 (65%) were male. The mean age of patients with D. folliculorum was 64.1 years and the mean age of patients without D. folliculorum was 52.7 years. Conclusion: In patients with blepharitis, the incidence of Demodex increases with age.

Novel In-Office Technique for Visual Confirmation of Demodex Infestation in Blepharitic Patients.

PURPOSE: To determine whether Demodex infestation in blepharitic patients can be confirmed by slit-lamp examination without the need for light microscopy. METHODS: Demodex infestation was evaluated in 16 patients presenting with blepharitis and cylindrical dandruff at a single medical center from November 2014 to February 2015. Two lashes with cylindrical dandruff were epilated from each lid (8 per patient, total 128), mounted on slides, and examined in the clinic under a slit lamp equipped with a 90D condensing lens followed by light microscopy in the pathology laboratory. All evaluations were performed by the same pathologist. Mites were identified by their characteristic morphology and movement patterns. Findings were compared between the 2 methods. RESULTS: The mean total Demodex count per lash was 1.5 ± 2.1 mites by using the slit lamp and 2 ± 2.9 mites by light microscopy. Corresponding counts per patient were 11.7 ± 9.4 and 16.1 ± 12.4. The correlation between the slit lamp and microscopy results was statistically significant, per lash (r = 0.922, P < 0.01) and per patient (r = 0.976, P < 0.01). On analysis by the more clinically relevant negative (no mites detected) or positive results (at least 1 mite detected), the accuracy of the slit-lamp examination for a single lash was 91.4% and the specificity and sensitivity were 89% and 94%, respectively; the negative predictive value was 93% [χ(1) = 87.94, P < 0.01)]. All 16 patients were positive for Demodex infestation by both methods (accuracy 100%). CONCLUSIONS: Demodex infestation in blepharitic patients with cylindrical dandruff can be confirmed using only a slit lamp and common eye clinic equipment.

Double-Masked and Unmasked Prospective Study of Terpinen-4-ol Lid Scrubs With Microblepharoexfoliation for the Treatment of Demodex Blepharitis.

PURPOSE: To evaluate terpinen-4-ol lid scrubs (Cliradex) with Microblepharoexfoliation (MBE) (BlephEx) in the treatment of Demodex blepharitis. METHODS: An Institutional Review Board (IRB) approved the randomized prospective double-masked trial of 50 patients with Demodex positive blepharitis. All subjects were given an in-office MBE treatment and randomized to masked lid scrubs (terpinen-4-ol or sham) twice daily for 1 month. All subjects then returned for an additional MBE treatment and received open-label terpinen-4-ol scrubs twice daily for 1 month. OUTCOMES: Demodex levels, Ocular Surface Disease Index, tear osmolarity, MMP-9, Schirmer 1 and grading of the lid margin appearance, meibomian gland dropout, and meibomian gland secretions. RESULTS: Forty-six subjects (23 per group) were included for the analysis; 4 lost to follow up. Total Demodex folliculorum levels in the Cliradex group improved: 4.7 to 3.6 (first month interval P = 0.266) to 2.6 (second month interval P = 0.279), overall P < 0.05 over 2 months. Total levels in the sham group improved: 5.1 to 3.0 (first month interval P < 0.05) to 2.5 (second month interval P = 0.496), overall P < 0.05 over 2 months. No clear statistically meaningful improvements in other dry eye and blepharitis data metrics were observed. CONCLUSIONS: In-office MBE treatments combined with either Cliradex terpinen-4-ol medicated lid scrubs or sham scrubs showed a statistically significant reduction in D. folliculorum infestation levels; however, conclusions on clinical significance could not be made. In-office MBE with terpinen-4-ol lid scrubs showed no significant improvement over sham scrubs.

Increased frequency of Demodex blepharitis in rosacea and facial demodicosis patients.

BACKGROUND: Rosacea is an inflammatory disease with 50% of ocular involvement rate. Primary demodicosis is an eruption caused by Demodex mites, and there is no data about the rate of ocular involvement in primary demodicosis. AIMS: In this cross-sectional study, it is aimed to reveal the frequency of Demodex blepharitis in rosacea and primary demodicosis patients. METHODS: In total, 58 rosacea, 33 primary demodicosis patients, and 31 healthy volunteers were included in the study. Four samples were obtained from eyelashes with a forceps and from facial skin by standardized skin surface biopsy. A positive result is described as detecting at least one Demodex mite on an eyelash or at five mites in the face. The patients were also examined by an ophthalmologist in terms of ocular involvement. RESULTS: Both rosacea and primary demodicosis patients had significantly more complaints like burning and stinging in the eyes compared to the control patients (P = .001). Primary demodicosis and papulopustular rosacea patients had the highest numbers of eyelash mites, respectively, and significantly a higher rate of blepharitis than the control group. CONCLUSION: As a result, the Demodex count was significantly higher in the primary demodicosis and rosacea patients than the control group. We think that every Demodex-positive patients should be evaluated for also eyelash mites to prevent a possible chronic blepharitis.

The effect of lid hygiene on the tear film and ocular surface, and the prevalence of Demodex blepharitis in university students.

AIM: To evaluate the effect blepharitis lid cleansers have on the tear film and ocular surface, and to examine the prevalence of Demodex folliculorum in a young population. METHODS: Forty-eight university students completed a randomised, controlled, investigator-masked, eight-week clinical trial. Three eyelid hygiene products were investigated: blepharitis eyelid cleanser (OCuSOFT® Lid Scrub® PLUS foam), diluted baby shampoo (10% Johnson's® No More Tears ®) and a tea-tree based face wash (dr.organic®). Cooled boiled water was used as a control. Subjects attended for four visits: baseline, two weeks, four weeks and eight weeks. At each visit, subjective symptoms, non-invasive tear break up time, ocular surface staining and Demodex folliculorum investigation were assessed to evaluate any positive or negative effect on the tear film and ocular surface. Osmolarity was also measured at baseline and week eight only. RESULTS: The overall prevalence of Demodex folliculorum found at baseline was 15%. Subjective symptoms improved in all groups, including control. There was no significant difference in mean osmolarity between the groups or within each group after eight weeks. There was a significant increase in osmolarity inter-eye variability in the baby shampoo group (5.5 ±â€¯5.4 vs 15.2 ±â€¯9.5; p = 0.03). There was no significant change in non-invasive tear break up time or ocular surface staining demonstrated after eight weeks of eyelid hygiene. CONCLUSION: A low prevalence of Demodex folliculorum can be found in a young population. All blepharitis lid cleansers used demonstrated subjective improvement in symptoms, with no negative effects on tear break-up time or ocular surface staining. The blepharitis eyelid cleanser and tea-tree based face wash revealed no adverse effect on mean osmolarity or inter-eye variability. Similarly, baby shampoo did not cause a significant increase in mean osmolarity, however, a significant increase in inter-eye variability was found; suggesting a possible increase in ocular surface inflammation.

The Clinical Use of Eyelash Manipulation in the Diagnosis of Demodex folliculorum Blepharitis.

OBJECTIVES: To compare the efficacy of using an eyelash manipulation technique to the traditional eyelash epilation and subsequent microscopic examination technique, when investigating for the presence of Demodex folliculorum in a clinical setting. METHODS: Four hundred twenty-eight eyelashes of 107 subjects were chosen to compare the quantity of D. folliculorum visible on eyelash manipulation with the slitlamp biomicroscope to that counted on microscopic examination of the same epilated eyelash. One eyelash from each eyelid was rotated with sterile forceps in situ, and the number of D. folliculorum seen emerging from the follicle was counted. The same eyelash was then epilated, and the number of D. folliculorum on the epilated eyelash was counted. Data were analyzed to check for agreement between the two techniques. RESULTS: Intraclass correlation coefficient showed moderately good agreement for assessing the quantity of D. folliculorum (0.78) between the techniques. However, the Bland-Altman plot suggested that consistently higher quantities were found on eyelash manipulation. The overall mean quantity of D. folliculorum was also greater on eyelash manipulation (1.45 mites; range, 0-13 mites) than on microscopic examination of the epilated eyelash (0.81 mites; range, 0-16; P= <0.001). Weighted kappa (κw=0.56) indicated weak levels of agreement between the two methods for addressing severity of infestation. CONCLUSION: Eyelash manipulation exhibited larger quantities of D. folliculorum than complete epilation of the eyelash. In a clinical setting, complete eyelash epilation is not necessary to accurately detect Demodex blepharitis requiring treatment.

Comparison of Efficacy and Safety of Two Tea Tree Oil-Based Formulations in Patients with Chronic Blepharitis: A Double-Blinded Randomized Clinical Trial.

INTRODUCTION: It was aimed to evaluate the efficacy of two tea tree oil (TTO)-based cleansing gels in chronic blepharitis patients. METHODS: Group-1 (basic gel containing 3%(w/w)-TTO) included 50 eyes of 25 patients and group-2 (advanced gel containing 3%(w/w)-TTO plus essential oils and vitamins) included 48 eyes of 24 patients. Ocular Surface Disease Index (OSDI), tear breakup time (TBUT), ocular surface staining pattern, Schirmer's test, impression cytology, Demodex presence and TNF-α, IL-6, IL-1ß levels were evaluated at the first visit and 1 month after treatment. RESULTS: In both groups, the mean OSDI score decreased (p1:0.001, p2:0.001), TBUT increased (p1:0.002, p2:0.004). In group-1, Demodex presence decreased from 42% to 27.8%; in group-2 from 54.2% to 20.6% (p1:0.302, p2:0.004). IL-1ß and IL-6 decreased in group-2 (p1:0.002, p2:0.050). TNF-α decreased in both groups (p1:0.001, p2:0.001). CONCLUSION: Both formulations improved ocular surface parameters. Group 2 showed more reduction in tear cytokines and Demodex count.

Improved Demodex diagnosis in the clinical setting using a novel in situ technique.

PURPOSE: To compare existing and novel diagnostic techniques for confirming ocular Demodex infestation and to recommend the most reliable method for routine use by eye care practitioners, based on yield and clinical applicability. METHODS: Fifteen participants with a prior Demodex blepharitis diagnosis or featuring typical cylindrical dandruff (CD) collarettes, and seven healthy controls were enrolled. Demodex presence was assessed using five techniques, applied consecutively, on a minimum of two different eyelashes on each eyelid of every participant, for each test, in situ: 1. using fine-point forceps and 25-40x biomicroscopy magnification, by eyelash rotation as proposed by Mastrota (ROT); 2. by removing cylindrical dandruff and exposing the eyelash insertion point at the lid margin (CDR); and 3. by laterally tensioning the eyelash (LET) following CDR. The typical appearance of cigar-shaped mite tails protruding from each assessed eyelash follicle was observed, and mite tails counted and averaged per participant for each assessment technique. 4. Lash epilation, and mite presence evaluated using bright-field microscopy at 10-40x magnification (EPI). 5. Finally, eyelash follicles were imaged using in vivo confocal microscopy (IVCM) and the images visually inspected for mite presence. RESULTS: In the Demodex group, the highest numbers of mites/eyelash were identified by LET (3.8 ± 1.4), versus CDR (2.4 ± 1.6) and ROT (1.1 ± 1.2), alone (all p < 0.002). An average of 1.0 ± 0.8 mites/lash was identified by EPI. IVCM failed to offer unequivocal evidence of Demodex presence even in confimed cases. CONCLUSIONS: A novel technique for the clinical diagnosis and grading of Demodex in situ is described. By removing cylindrical dandruff and applying static, lateral tension to the eyelash without epilation, large numbers of mites are visible at the exposed eyelash follicle. The proposed method is convenient and clinically applicable, requiring only forceps and 25-40x biomicroscope magnification, and allowing rapid, efficient evaluation of large numbers of eyelashes.