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Demodicosis occupies a leading position among all dermatoses. According to ICD-10, it is not distinguished as a separate disease; it belongs to the class of parasitic diseases. The relevance of studying the problem of ophthalmodemodecosis is caused by its high prevalence and contagiousness, chronic course, an open issue of the role of the Demodex mite in the occurrence of inflammatory eye diseases, as well as the lack of effective methods for treating and preventing this pathology. In addition, Demodex causes discomfort and contributes to the occurrence of cosmetic defects, which in turn worsens the patient’s quality of life.The aim. To present a review of the literature data and our own results of laboratory diagnostics of ophthalmodemodecosis.Materials and methods. The article presents clinical cases of demodectic eyelid lesions with different disease outcomes in case of similar treatment. Laboratory diagnostics included drawing up an acarogram. Epilated eyelashes were used as a material for detecting mites on eyelids. Counting of individuals was carried out using light microscopy; all forms of mite development were taken into account. The work presents the statistics on the frequency of examination of patients with suspected demodicosis at different times of the year, confirming the seasonality of this disease. The literature review included data on the history of studying the Demodex mite, existing hypotheses and theories about its pathogenesis, as well as the information on domestic and foreign methods of treating ophthalmodecosis, including modern hardware techniques.Results. Demodex mites play a significant role in the development of blepharitis and blepharoconjunctivitis. It is important to consider that demodicosis can occur against the background of inflammatory eye diseases of another etiology. Therapy for ophthalmodemodecosis currently remains complex, lengthy and ineffective. When assessing the results of an acarogram, any detected stages of a mite are clinically significant, and there isn’t a direct relationship between the number of detected mites and the severity of clinical manifestations in all cases.

Rosacea is a chronic inflammatory disease that usually affects the central part of the face. The primary symptoms include facial flushing, persistent erythema, telangiectasia, inflammatory pustules and papules. Based on groups of these symptoms, four basic rosacea subtypes have been defined: erythematotelangiectatic, papulopustular, ocular, phymatous; and one variant, granulomatous rosacea. Although the pathophysiology of this disorder is not fully known, many components such as immune and neurovascular dysregulation, oxidative stress, genetic background, gut microbiome, skin microbiome as well as external aspects are thought to play a role. In this article, we present the main factors that are speculated to be involved in the pathogenesis of rosacea. Methods and materials: We reviewed the literature available on PubMed and Google Scholar using the words "rosacea”, „rosacea pathogenesis”, „demodex”, „reactive oxygen species”, „rosacea microbiome”. Summary Rosacea is a chronic dermatosis whose etiology, despite many studies, is not fully understood. Currently, an abnormal inflammatory reaction caused by excessive stimulation of TLR-2 receptors is suspected as the main factor in the pathomechanism of the disease. Vascular disorders, transmission disorders, genetic factors, skin and intestinal dysbiosis also participate in the pathogenesis of rosacea. It is assumed that exogenous factors such as diet and exposure to UV radiation also play a role in the development of the disease.

Background. The article provides a detailed review of the etiopathogenetic, clinical and diagnostic aspects of demodectic skin of the face, considers the modern classification of this pathological condition, provides statistical data on the sex and age structure of population invasion by a tick of the genus Demodex, as well as the percentage of complications with secondary demodicosis of acneform dermatoses (rosacea and perioral dermatitis). Aim. To reveal the percentage of complications of the course of acneform dermatoses (perioral dermatitis and rosacea) with demodicosis, depending on the severity of the underlying disease, as well as the sex and age structure of the invasion among the patients of the study group. Materials and methods. In our own study, we assessed the sex and age structure of the Demodex mite infestation and the percentage of complications of rosacea and perioral dermatitis with secondary demodicosis, depending on their severity. The severity of clinical manifestations of rosacea was assessed using the rosacea diagnostic assessment scale; the PODSI index was used for perioral dermatitis. Before the start of the course of therapy and after its completion, all patients underwent a microscopic examination of scrapings from the skin of the face in order to detect a diagnostically significant number of individuals of the Demodex genus tick (5 or more). If a tick was found in scrapings, along with standard therapy drugs, patients were locally prescribed 1% ivermectin cream once a day for a course of 2 to 4 months, depending on the severity of the clinical manifestations of dermatosis. Results. It was found that the incidence of Demodex invasion in the study group increased in direct proportion to the severity of the clinical manifestations of dermatoses and the age of the patients. It was also found that among the patients of the study group, demodicosis was registered in women almost twice as often as in men. Topical use of 1% ivermectin cream has shown a high profile of the efficacy and safety of this drug. Conclusion. After the completing the treatment course, complete elimination of Demodex, confirmed by laboratory, was achieved in 100% of patients with demodicosis in the study group. There were no adverse events or side effects while taking the drug.

Purpose: to study the possibilities of laser Doppler flowmetryin assessing the effectiveness of treatment of chronic Demodex blepharitis. Material and methods. The study included 33 patients (66 eyes), divided into the main and the control groups, identical in gender and age structure. The main group consisted of 16 patients (32 eyes) with chronic Demodex blepharitis. The control group included 17 patients (34 eyes) with no signs of changes in the structures of the anterior eye segment. In addition to the standard ophthalmologic examination, the patients underwent an eyelid skin microcirculation examination (using the Analyzer of peripheral blood and lymph flow LASMA MC-1 and laser diagnostic complex LASMA MC, produced by LASMA firm). The patients of the main group used Dexodem Phyto cream gel for 45 days, whereupon, after 1.5 months, an efficacy control examination was performed. Results. In the main group, typical microcirculatory disorders - arterial hyperemia of the upper eyelid and lower eyelid ischemia, and insufficient activity of the lymph of the upper eyelid - were revealed prior to treatment. After treatment, positive changes were clinically observed. Microcirculation parameters, including the perfusion and the amplitude-frequency spectrum of blood flow of both eyelids approached the normal values, and the activity of the lymphatic system improved. Conclusion. The laser Doppler flowmetry enables the examination of blood flow and lymph flow in inflammatory diseases of the eyelids, in particular blepharitis, and may be considered as an objective method of treatment effectiveness evaluation // Russian ophthalmological journal. 2017; 10 (2): 62-6. (in Russian). doi: 10.21516/2072-0076-2017-10-2-62-66.

We present a description of the clinical case of a patient with an erythematotelangiectatic type of rosacea. Rosacea is a chronic recurrent dermatosis, characterized by skin lesions of the face in the form of erythema and papulopustular elements, which has polyethological origin. The disease occurs more frequently in women aged 30-50 years who have a certain genetic predisposition to transient reddening of the skin of the face or less often of the neck and the decollete zone. It is believed that the dermatosis is more likely to affect the I and II phototypes, but the disease can occur in any skin phototype. The patient came to the clinic with complaints about rashes in the chin and nasolabial triangle, flushing of the face, accompanied by tingling and burning. The patient turned to the clinic with complaints about rashes in the chin and nasolabial triangle, flushing of the face, accompanied by tingling and burning. She never consulted a dermatologist before. A diagnosis was made: “erythematotelangiectatic type of rosacea” (according to the classification proposed by the USA National Rosacea Society, stage I — persistent erythema and telangiectasia). Using the scale of diagnostic evaluation of rosacea, it was evaluated at 12 points. There are many approaches to the treatment of rosacea. Drug therapy is divided into systemic, external and complex. Systemic therapy has a number of side effects, so for light and medium-to- severe rosacea, only external therapy is more often prescribed. Because of the presence of pathologically altered vessels, the low efficacy of metronidazole, the patient was assigned a course of phototherapy with intense incoherent pulsating light at standard parameters. There was a significant improvement after two procedures, but vessels smaller than 0.4 mm remained intact, so the duration of the first pulse was increased in order to influence small- caliber vessels. Individual selection of parameters (duration of the first impulse and fluence) was made based on the dermatoscopic picture and patient’s phototype, which resulted in a significant clinical effect and persistent remission. Using the scale of diagnostic evaluation of rosacea it was evaluated at 1 point after treatment. This clinical case demonstrates the effectiveness of phototherapy with intense incoherent pulsating light with individual selection of the duration of the first pulse and energy density in patients with erythematotelangiectatic rosacea. In IPL-treatment schemes, it is desirable to select individual parameters for the duration of the first pulse and the energy density, based on the features of the dermatoscopic picture and skin phototype of each individual patient.

This literature review examines principal aspects of rosacea prevalence in the Russian Federation and abroad, shows present-day opinions about the pathogenesis and histological picture of rosacea and presents actual classification and a number of key clinical forms of the disease.

Purpose. To assess the impact efficacy of a lacrimal substitutive component in the comlex treatment of posterior blepharitis combined with demodecosis lesions of the eyelid margins.Material and methods. The study performed examinations of 150 patients with posterior blepharitis combined with demodicosis of eyelids (PBDEL). The patients were divided into 4 main groups and a control group 30 individuals in each. The following investigations were performed: Norn test, Schirmer test 1, compression test and biometry of lacrimal meniscus; as well as the laboratory test of eyelashes for a Demodex presence. A stage-by-stage treatment was carried out: DEXAGentamicin 2 times a day for 10 days (the 1st stage); eyelid massage with hygiene procedures – warm compresses and Tea-gel 2 times a day for 1.5 months (the 2nd stage); Glycodem 2 times a day for 45 days (the 3rd stage). Lacrimal substitutive medications (LSM) of different viscosity were administered 4 times a day for 6 months at all stages of treatment. The group 1 used LSM medicines on the basis of Hydroxypropilger, the group 2 – on the basis of Carmellose sodium (Trehalose), the group 3 – on the basis of Carbomer 984 and the group 4 – on the basis of Hypromellose. The LS medications were not prescribed in the control group.Results. The stage-by-stage treatment combined with pathogenetic lacrimal substitutive therapy in PBDEL patients achieves the best results. Application of multi-component LSM (systain balance and optiv) compared to the single component LSM (oftagel and natural tears), leads to a long-term remission of subjective and objective PBDEL symptoms. The 1st and 2nd stages of treatment (anti-inflammatory therapy, massage of the eyelids combined with hygiene procedures using tear substitutes) already reduce the quantity of Demodex mites up to the threshold values, as well as create conditions for efficiency of the third stage of antiparasitic therapy. Norn test and biometry of lacrimal meniscus is the most significant (in comparison with Schirmer test 1) for a control of treatment results.Conclusion. The performed study showed that pathogenetic lacrimal substitutive therapy contributes to a liquefaction of the meibomian glands secretion, which in turn promotes a restoration of the tear film and a prolonged remission of symptoms of posterior blepharitis and also in some cases leads to the exit of Demodex mites from the meibomian glands to the eyelid margins that increases the efficiency of anti-parasitic therapy. In addition to hygiene procedures, the LSM application should be an obligatory component at all stages of treatment of patients with posterior blepharitis combined with demodicosis of eyelids.

Purpose. Optimization of conservative treatment of blepharitis of demodicosis etiology for an improvement of clinical results, confirmed by microscopic studies.Material and methods. There were examined 200 patients with diagnosis «Demodex blepharitis» (162 female and 38 male). The patients were divided randomizing into two groups of 100 individuals in each (200 eyes in each group). In the main group the eyelash margin of eyelids were treated using the 10% Benzyl benzoate ointment, Uniderm and Emolium creams according to a short 4-day scheme twice a day. Two weeks later, the treatment was repeated. The control group received a treatment according to the universal 45-day scheme, which included the treatment of eyelash margin of eyelids using alcoholic solution of calendula, Glycodem gel, and instillation of Vitabact drops twice a day. Results of the treatment were evaluated in the main group after the first course (5th day) and after the second course 2 weeks later (23rd day), and in the control group – on the 46th day from the treatment start. In addition, long-term results were assessed 1 and 6 months after the treatment. Statistical analysis of obtained data was performed using the Statistica 10.0 software.Results. According to the results of eyelashes microscopy after the performed treatment in the main group Demodex was not found in 76%, and after the repeated course two weeks later the result was in 87%. In the control group the Demodex absence in the specimen was observed only in 42%. According to the evaluation results of clinical efficacy a reduction of signs (deposits on the eyelashes, eyelid hyperemia, condition of excretory ducts of meibomian glands, presence of discharge) was observed in the main group more than 2 times, in contrast to the control group. The quantity of recurrence cases was studied during the longterm follow-up 1 and 6 months after the treatment and it was in the main group – 29 and 42 cases, respectively, and in the control group – 62 and 82 cases, respectively.Conclusion. Thus, the proposed scheme of treatment of demodex blepharitis etiology in case of substantial reduction of treatment period provides a high clinical efficacy, confirmed by microscopic examination data and a risk decrease of incidence of recurrent disease more than twice.

Purpose: The study comparatively evaluates the effectiveness of various approaches to acaricidal treatment in patients with chronic demodex blepharitis and meibomian gland dysfunctions., Material and Methods: The study included 40 patients with chronic blepharitis (CB) of demodicosis etiology in conditions of meibomian gland dysfunction (MGD) and dry eye (DE). The 1 st group of patients (20 people) received acaricidal treatment as part of therapeutic eyelid hygiene (TEH; 2 times a day) involving the use of «Blefarogel ochishchenie», «Blefarolosion», «Blefarogel forte» (contains sulfur and metronidazole). Acaricidal treatment in the patients of the 2 nd group involved applications of a product containing metronidazole (2 times a day) without TEH. Control points: 1) at inclusion in the study; 2) after a course of therapy (45 days). Evaluation included: patient acarograms, symptoms and signs of CB (points); OSDI; tear film break-up time (TBUT, sec), severity of meibomian gland dysfunction (S-MGD, points). Statistical analysis: calculation of M ± SD , Mann-Whitney, and Wilcoxon tests., Results: Acaricidal treatment was effective in both groups (reduction in demodex population, which was more pronounced in the 1 st group). Symptoms and signs of CB were significantly less pronounced in the patients of the 1 st group after therapy. The patients of the 1 st group showed a significant decrease in S-MGD, OSDI and an increase in TBUT, the 2 nd group - a significant decrease in OSDI and an increase in TBUT at the second control point. The positive OSDI and TBUT trends were significantly more pronounced in the 1 st group., Conclusion: Acaricidal treatment as part of TEH showed a significantly more pronounced reduction in demodex population, relief of CB symptoms and sign, OSDI decrease and TBUT increase, compared to the 2 nd group. Apparently, this was associated with combined acaricidal effect and significant S-MGD decrease in the patients of the 1 st group.

The most effective method of treating chronic blepharitis - a disease with multifactorial pathogenesis requiring an individual approach - is a combination of remedial measures that addresses eyelids hygiene and includes medicated and device therapy.

Aim: To study possibilities of using the medication Ophthalmoferon in the treatment of children with chronic allergic and Demodex blepharoconjunctivitis., Material and Methods: We examined 40 children (80 eyes) aged 3 to 17 years with chronic allergic (group I) and Demodex (group II) blepharoconjunctivitis. Each group was divided into two subgroups ('A' and 'B') respectively based on the treatment regimen used. Subgroup 'A' patients received Ophtalmoferon instillations (four times per day for four weeks) in addition to the standard therapy, whereas subgroup 'B' patients got only basic treatment of blepharoconjunctivitis. The latter included eyelids' ciliary edge massage, eyelids' free edge hygienic treatment, artificial tears instillations and oral intake of the medications, like enterosorbents, probiotics, enzymes and anti-allergic remedies. We evaluated the dynamics of subjective and objective blepharoconjunctivitis signs at 1,2,4 and 6 follow-up weeks. The dynamics of eosinophils content in cytograms as well as the dynamics of acarograms were also assessed., Results: From the first treatment week in all patients, regardless of the treatment regimen used, we noted a statistically significant positive change in all subjective and the majority of objective blepharoconjunctivitis clinical manifestations, such as eyelids' edge and conjunctiva hyperemia and eyelid swelling. In patients with allergic and Demodex blepharoconjunctivitis, who received the medication Ophtalmoferon, a significantly more positive result was observed after the first treatment week, by comparing with the control group (p<0,01). The significant difference in the parameters of both comparison subgroups persisted for two weeks. There was a significant difference in the acarogram values, when Ophtalmoferon was used. A further decrease in the cellular infiltration of the conjunctiva by eosinophils was revealed in patients, who additionally used Ophthalmoferon, but without significant differences in parameters. There were no adverse effects in all cases, when the given medication was used., Conclusion: Our study results allow us to recommend the medication Ophtalmoferon for a wide clinical use in children with chronic allergic and Demodex blepharoconjunctivitis.