Update in Demodex Blepharitis

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Siripong Siramon
Latiporn Udomsuk
Tanit Wongwibulsin

Abstract

Nowadays chronic blepharitis that does not respond to conventional treatment is associated with increasing number of Demodex at eyelid. In human eye, there are two species of mites which are Demodex folliculorum and Demodex brevis. Due to their habitat of these 2 species are different which cause different kind of anterior and posterior blepharitis, respectively. Ocular symptoms of Demodex blepharitis are overlap to the other ocular surface disease but symptoms may worsen than the others.  This reason may be the cause of delayed diagnosis and ineffective management of Demodex blepharitis. Pathognomonic sign of this disease is the cylindrical dandruff around lash follicle. There are many methods for confirm diagnosis which the most popular method is lash sampling and exam under microscope. Mode of common treatments presently, there are many commercial eyelid cleansers that contained tea tree oil in various concentration in the market or oral ivermectin but all of these cannot get rid of Demodex mite after 4 weeks of treatment. So Demodex blepharitis is the chronic disease that challenges both diagnosis and proper treatment for the quality of chronic blepharitis patients in the future.

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References

1. Cheng AM, Sheha H, Tseng SC. Recent advances on ocular Demodex infestation. Curr Opin Ophthalmol. 2015; 26: 295–300.
2. Marcinowska Z, Kosik-Bogacka D, Łanocha-Arendarczyk N, Czepita D, Łanocha A. Demodex folliculorum and Demodex brevis. Pom J Life Sci 2015; 61: 108–14.
3. Fromstein SR, Harthan JS, Patel J, Opitz DL. Demodex blepharitis: clinical perspectives. Clin Optom (Auckl) 2018; 10: 57-63.
4. Herron MD, O’Reilly MA, Vanderhooft SL. Refractory Demodex folliculitis in five children with acute lymphoblastic leukemia. Pediatr Dermatol 2005; 22: 407–11.
5. Biernat MM, Rusiecka-Ziołkowska J, Piątkowska E, Helemejko I, Biernat P, Gościniak G. Occurrence of Demodex species in patients with blepharitis and in healthy individuals: a 10-year observational study. Jpn J Ophthalmo 2018; 62: 628-33.
6. Kaya S, Selimoglu MA, Kaya OA, Ozgen U. Prevalence of Demodex folliculorum and Demodex brevis in childhood malnutrition and malignancy. Pediatr Int 2013; 55: 85–9.
7. Zhao YE, Wu LP, Peng Y, Cheng H. Retrospective Analysis of the Association Between Demodex Infestation and Rosacea. Arch Dermatol 2010; 146: 896-902.
8. Liu JB, Sheha H, Tseng SCG. Pathogenic role of Demodex mites in blepharitis. Curr Opin Allergy Clin Immunol 2010; 10: 505–10.
9. Morras PG, Santos SP, Imedio IL, Echeverria ML, Hermosa JM. Rosacea-like demodicidosis in an immunocompromised child. Pediatr Dermatol 2003; 20: 28–30.
10. Liang L, Safran S, Gao Y, Sheha H, Raju VK, Tseng SCG. Ocular demodicosis as a potential cause of pediatric blepharoconjunctivitis. Cornea 2010; 29: 1386–91.
11. Gao YY, Di Pascuale MA, Elizondo A, Tseng SC. Clinical treatment of ocular demodecosis by lid scrub with tea tree oil. Cornea 2007; 26: 136–43.
12. Kheirkhah A, Casas V, Li W, Raju VK, Tseng SC. Corneal manifestations of ocular Demodex infestation. Am J Ophthalmol 2007; 143: 743–9.
13. Rodriguez AE, Ferrer C, Alio JL. Chronic blepharitis and Demodex. Arch Soc Esp Oftalmol 2005; 80: 635–42.
14. Zhao YE, Wu LP, Hu L, Xu JR. Association of Blepharitis with Demodex: A Meta-analysis. Ophthalmic Epidemiol 2012; 19: 95-102.
15. Forton F, Seys B. Density of Demodex folliculorum in rosacea: A case control study using standardized skin-surface biopsy. Br J Dermatol 1993; 128: 650–9.
16. Randon M, Liang H, El Hamdaoui M, Tahiri R, Batellier L, Denoyer A, et al. In vivo confocal microscopy as a novel and reliable tool for the diagnosis of Demodex eyelid infestation. Br J Ophthalmol 2015; 99: 336–41.
17. Murphy O, O’ Dwyer V, Lloyd-McKernan A. The Clinical Use of Eyelash Manipulation in the Diagnosis of Demodex folliculorum Blepharitis. Eye Contact Lens. DOI:10.1097/ICL.0000000000000608 (inpress)
18. Kim JT, Lee SH, Chun YS, Kim JC. Tear cytokines and chemokines in patients with Demodex blepharitis. Cytokine 2011; 53: 94-9.
19. Gao YY, Di Pascuale MA, Li W, Liu DT, Baradaran-Rafii A, Elizondo A, et al. High prevalence of ocular Demodex in lashes with cylindrical dandruffs. Invest Ophthalmol Vis Sci 2005; 46: 3089–94.
20. Koksal M, Kargi S, Taysi BN, Ugurbas SH. A rare agent of chalazion: demodectic mites. Can J Ophthalmol 2003; 38: 605–6.
21. English FP, Iwamoto T, Darrell RW, DeVoe AG. The vector potential of Demodex folliculorum. Arch Ophthalmol 1970; 84: 83–5.
22. Lacey N, Delaney S, Kavanagh K, Powell FC. Mite-related bacterial antigens stimulate inflammatory cells in rosacea. Br J Dermatol 2007; 157: 474-81.
23. Szkaradkiewicz A, Chudzicka-Strugała I, Karpin´ ski TM, Gos´lin´ska-Pawłowska O, Tułecka T, Chudzicki W, et al. Bacillus oleronius and Demodex mite infestation in patients with chronic blepharitis. Clin Microbiol Infect 2011; 18: 1020-5.
24. Lacey N, Delaney S, Kavanagh K, Powell FC. Mite-related bacterial antigens stimulate inflammatory cells in rosacea. Br J Dermatol 2007; 157: 474–81
25. Li J, O’Reilly N, Sheha H, Katz R, Raju VK, Kavanagh K, et al. Correlation between ocular Demodex infestation and serum immunoreactivity to bacillus proteins in patients with facial rosacea. Ophthalmology 2010; 117: 870–7.
26. Bevins CL, Liu FT. Rosacea: skin innate immunity gone awry? Nat Med 2007; 13: 904–6.
27. Georgala S, Katoulis AC, Kylafis GD, Koumantaki-Mathioudaki E, Georgala C, Aroni K. Increased density of Demodex folliculorum and evidence of delayed hypersensitivity reaction in subjects with papulopustular rosacea. J Eur Acad Dermatol Venereol 2001; 15: 441-4.
28. Rabensteiner DF, Aminfar H, Boldin I, Nitsche-Resch M, Berisha B, Schwantzer G, et al. Demodex Mite Infestation and its Associations with Tear Film and Ocular Surface Parameters in Patients with Ocular Discomfort. Am J Ophthalmol 2019; 204: 7-12.
29. Coston TO. Demodex folliculorum blepharitis. Trans Am Ophthalmol Soc 1967; 65: 361–92.
30. Kaya A, Gürdal C. Office-based diagnosis of demodex using smartphone. Eye Contact Lens 2018; 44: e25-6.
31. Mastrota KM. Method to identify Demodex in the eyelash follicle without epilation. Optom Vis Sci 2013; 90: e172–4.
32. Jones L, Downie LE, Korb D, Benitez-del-Castillo JM, Dana R, Deng SX, et al. TFOS DEWS II management and therapy report. Ocul Surf 2017; 3: 575-628.
33. Wong K, Flanagan J, Jalbert I, Tan J. The effect of BlephadexTM Eyelid Wipes on Demodex mites, ocular microbiota, bacterial lipase and comfort: a pilot study. Cont Lens Anterior Eye DOI: 10.1016/j.clae.2019.06.001 (inpress)
34. Holzchuh FG, Hida RY, Moscovici BK, Villa Albers MB, Santo RM, Kara-Jose N, et al. Clinical treatment of ocular Demodex folliculorum by systemic ivermectin. Am J Ophthalmol 2011; 151: 1030-4.
35. Filho PA, Hazarbassanov RM, Grisolia AB, Pazos HB, Kaiserman I, Gomes JA. The efficacy of oral ivermectin for the treatment of chronic blepharitis in patients tested positive for Demodex spp. Br J Ophthalmol 2011; 95: 893-5.
36. Koo H, Kim TH, Kim KW, Wee SW, Chun YS, Kim JC. Ocular surface discomfort and Demodex: effect of tea tree oil eyelid scrub in Demodex blepharitis. J Korean Med Sci 2012; 27: 1574-9.
37. Gao YY, Xu DL, Huang IJ, Wang R, Tseng SC. Treatment of ocular itching associated with ocular demodicosis by 5% tea tree oil ointment. Cornea 2012; 31: 14-7.
38. Salem DA, El-Shazly A, Nabih N, El-Bayoumy Y, Saleh S. Evaluation of the efficacy of oral ivermectin in comparison with ivermectin-metronidazole combined therapy in the treatment of ocular and skin lesions of Demodex folliculorum. Int J Infect Dis 2013; 17: 343-7.