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Purpose: The aim of this study was to evaluate the long-term outcomes of lotilaner ophthalmic solution, 0.25%, in the treatment of Demodex blepharitis., Methods: This observational, extension study included patients with Demodex blepharitis (N = 239) who completed the Saturn-1 study and presented for the day 180 visit. All participants were assessed at days 180 and 365 after the initiation of 6-week treatment with the study drug or its vehicle., Results: The proportion of patients with 0 to 2 collarettes (grade 0) was significantly higher in the study group (N = 128 patients) than in the control group (N = 111 patients) (39.8% vs. 2.7% at day 180 and 23.5% vs. 2.9% at day 365; P < 0.0001). Similarly, the proportion of patients with ≤10 collarettes (collarette grade 0-1) in the study group was significantly higher than in the control group (70.3% vs. 18.0% at day 180 and 62.6% vs. 21.9% at day 365; P < 0.0001). In the study group, erythema continued to improve even after completion of the 6-week lotilaner treatment. No serious ocular adverse events were observed in the study group, and there was 1 treatment-related ocular adverse event in the study group, which was considered mild., Conclusions: After 6-week treatment with lotilaner ophthalmic solution, 0.25%, for Demodex blepharitis, no long-term concerns were observed during 1 year of follow-up. A high proportion of patients with 0 to 2 collarettes (grade 0) or ≤10 collarettes (collarette grade of 0 or 1) was observed throughout 1 year of follow-up, indicating that the efficacy of lotilaner ophthalmic solution, 0.25%, against Demodex blepharitis may last well after completion of therapy., Competing Interests: E. Yeu has received consulting fees from, serves on the board of directors for, and is an equity stakeholder in Tarsus Pharmaceuticals. E. Sadri is a consultant for and an equity stakeholder in Tarsus Pharmaceuticals. I. B. Gaddie, J. B. Ciolino, and L. Nijm are consultants for Tarsus Pharmaceuticals. S. N. Baba and M. Holdbrook are or were employees of Tarsus Pharmaceuticals when this study was conducted. J. D. Paauw received research fees from Ora Clinical Research. The remaining authors have no conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

The prevalence of human Demodex mites has surged in recent years, prompting significant concern among both patients and the medical community. This study aimed to investigate the survival duration and morphological alterations of Demodex folliculorum under diverse temperature conditions and in various culture media. We employed the eyelash sampling technique to procure the mites. The collected specimens were then subjected to culture at two distinct temperature ranges (16-22 °C and 4 °C) across a spectrum of media, including 30% tea tree oil (TTO), phosphate-buffered saline (PBS), pure water, 0.9% physiological saline, 5 µg/ml propidium iodide (PI), liquid paraffin, glycerol, and a blank culture medium. Post-administration, the mites' activity and morphological changes were meticulously documented. Our findings indicate that the survival span of Demodex mites within the same medium was notably extended at 4 °C compared to room temperature. Specifically, under 4 °C, the use of liquid paraffin as a culture medium yielded the longest survival time of 12 days, surpassing all other conditions. Remarkably, the morphological integrity of the mites in this group remained largely unaltered. These results suggest that 4 °C is the optimal temperature for the in vitro cultivation of Demodex mites, offering insights into the environmental preferences of these organisms and potentially informing future therapeutic strategies., (© 2024. The Author(s).)

Demodex infestation is the cause of more than two-thirds of all cases of blepharitis in the United States. Although symptoms may include crustiness, redness, or itching of the eyelids, diagnosis can be accomplished through a simple examination of the eyelashes. The presence of a waste product of the Demodex mite, known as collarettes, on the base of the eyelashes is a pathognomonic sign of Demodex blepharitis. Demodex infestation that results in blepharitis may cause blockage and ultimately atrophy of the meibomian glands, worsening dry eye disease. Until recently, management of Demodex blepharitis has been limited by a lack of approved therapy options. Lotilaner ophthalmic solution 0.25%, the first approved therapy for treatment of Demodex blepharitis, has not only been shown to eradicate Demodex mites in one-half to two-thirds of patients following short-term treatment but also demonstrated continued benefits through 1 year of follow-up. In addition to managing Demodex blepharitis, treatment with lotilaner ophthalmic solution 0.25% may aid in the management of dry eye disease and other forms of ocular surface disease caused by complications of Demodex infestation. As a result, it is possible that successful management of Demodex blepharitis may reduce chronic use of health care resources dedicated to managing other chronic ocular conditions. As eye care professionals recognize Demodex infestation as a key mediator of ocular surface disease, increasing diagnostic awareness and addressing this underlying cause of Demodex blepharitis may reduce the need for specialist follow-up care, decrease the need for chronic therapy, and improve patient outcomes. Through routine screening for Demodex infestation and Demodex blepharitis, eye care professionals can now address an underlying factor in ocular surface disease to improve use of health care resources in the community.

Purpose: The aim of this study was to report clinical observations suggesting the efficacy of topical 1% 5-fluorouracil (5-FU) in treating Demodex -associated blepharitis., Methods: An observational retrospective review of 13 eyes from 13 individuals with conjunctival neoplastic lesions and concomitant Demodex lash infestation that received topical 1% 5-FU eye drops. Patients underwent slit-lamp examination at each follow-up visit. Clinical photographs of the lash line were obtained after treatment initiation. In a subset of patients, lashes were epilated bilaterally and microscopically analyzed for presence of Demodex mites before and after treatment initiation., Results: The mean age of the population was 68 ± 14 years (range: 30-84 years) and 92% were male. In all 13 patients, a marked reduction in cylindrical dandruff was noted in the treated eye by slit-lamp examination after 2 cycles of 5-FU. There was complete resolution of cylindrical dandruff in 10 of 13 treated eyes compared with 0 resolution of cylindrical dandruff in untreated eyes ( P = 0.0001). In the 6 patients who received epilation, the lashes from the treated eye showed no Demodex , whereas lashes from the fellow untreated eye revealed persistent Demodex ., Conclusions: Topical 1% 5-FU shows efficacy in treating Demodex -associated blepharitis. Further studies are indicated to reproduce our findings and evaluate the potential use of 5-FU as a treatment ingredient., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Pthiriasis palpebrarum, a rare condition caused by Phthirus pubis , can mimic blepharitis and manifest as intense itching, inflammation and eyelid redness. We describe a case of Pthiriasis palpebrarum in a young girl with right upper eyelid discomfort. A slit lamp examination revealed eggs on her eyelashes and adult lice on the eyelids' surface. Dermatology consultation confirmed the diagnosis and successful treatment followed. Family evaluation uncovered genital Phthiriasis pubis in her parents, who received appropriate treatment. This report emphasises the importance of accurate diagnosis and management of this masquerading condition by careful slit lamp and microscopic evaluation. It also highlights the significance of comprehensive family history and examination., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

A 2-year-old boy with recently treated head lice presented with worsening right eyelid pruritus, irritation, and bleeding that was presumed to be a reinfection of head lice. Clinical examination revealed ectoparasites along the superior eyelid margin that were later identified as Phthirus pubis , or pubic lice. Treatment and management strategies are discussed. [ J Pediatr Ophthalmol Strabismus . 2023;60(5):e55-e58.] .

Phthirus pubis infestation is a highly infectious parasitic disease, affecting 1.3-4.6% of people globally. However, the coinfestation of P. pubis on the eyelashes and scalp hairs in children is uncommon, and the clinical characteristics and prognosis have not been fully studied. In this retrospective study, we report five pediatric patients diagnosed with eyelash and scalp coinfestation of P. pubis. The samples were obtained after treatment and sent for pathological examination. The demographic and clinical characteristics of the study participants were analyzed in detail. Numerous lice and nits were detectable on the eyelashes and scalp hairs in all enrolled patients. The ages ranged from 2 to 5 years. The duration of onset ranged from 3 to 10 days. The common clinical presentations were itching (100%) and conjunctivitis (60%). Treatment included eyelash and scalp hair trimming to the root (100%) and mechanical removal of the parasites (100%), in addition to topical tobramycin eye ointment (100%) and phenothrin shampoo (80%). Symptoms resolved by a 1-week follow-up. Pediatric P. pubis coinfestation mainly occurs on the eyelashes and temporal scalp in females, and sometimes contact tracing fails to identify the source. Phthirus pubis infestation of eyelashes can be misdiagnosed as blepharoconjunctivitis. Sexually transmitted diseases should be ruled out for patients with P. pubis infestation. Untreated or persistent cases may lead to several serious infections.

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., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Abstract: Demodex is an important pathogen causing eyelid and eyelash diseases. This article describes a quick, efficient, cost-effective office-based imaging of demodex with the help of an intraocular lens (IOL) and smartphone-aided innovated tool. Eyelid photography of a 56-year-old man with suspected demodex infestation was obtained using a 20-diopter (D) IOL over the smartphone camera called as Anterior Segment Photography using IOL (ASPI). A video or photograph of the epilated eyelash was taken using four 30-D IOLs attached to the smartphone camera to form an optical system called IOLSCOPE, which clearly detected the demodex parasite. The importance of ASPI and IOLSCOPE for the rapid office-based diagnosis of demodex pathogen in peripheral health centers devoid of slitlamp and microscopes has been emphasized here., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2021 Contact Lens Association of Ophthalmologists.)

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., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

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., (© 2021. The Author(s).)

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.

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., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

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.

Demodex is a saprophytic mite of the ocular adnexa, which can in certain circumstances proliferate on the skin of the face and on the eyelid margins. It is involved in facial rosacea (especially in the papulopustular form) and in the development or aggravation of anterior and/or posterior blepharitis or even keratoconjunctivitis, often in association with cutaneous lesions ; the pathophysiology is often multifactorial. Symptoms are non-specific, but the presence of cylindrical sleeves on the eyelashes is very suggestive of infestation, and certain techniques of biomicroscopic examination or imaging, such as confocal microscopy in vivo, allow direct visualization of the parasite. Parasitological examination of the eyelashes can confirm the diagnosis and can be improved by good sampling technique. Eyelid hygiene and oil-based ointments are the cornerstone of treatment. New specific treatments, in particular topical treatments based on tea tree oil, ivermectin, as well as pulsed light therapy and micro-exfoliation of the eyelid margin, can help to reduce the parasitic load and improve symptoms., (Copyright © 2020. Published by Elsevier Masson SAS.)

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-1β 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-1β 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.

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., Competing Interests: None

Objective: To directly observe the in vitro real-time effects of intense pulsed light (IPL) on a Demodex mite extracted from an eyelash of a patient with ocular rosacea. Background: Demodex is a risk factor in the pathogenesis of oculofacial rosacea, meibomian gland dysfunction (MGD), and dry eye disease (DED). Recent studies suggested IPL to control or eradicate Demodex organisms in the periocular area. Despite encouraging reports, the direct effect of IPL on Demodex is not well understood. Methods: An eyelash infested with Demodex was epilated from a 62-year-old female patient with oculofacial rosacea. Following isolation and adherence of a mite onto a microscope slide, real-time video microscopy was used to capture live images of the organism before, during, and after administration of IPL pulses. IPL pulses were delivered with the M22 IPL (Lumenis), with IPL settings used for treatment of DED due to MGD (the "Toyos protocol"). A noncontact digital laser infrared thermometer was used to measure the temperature of the slide. Results: Before the IPL pulses, legs of the Demodex mite spontaneously moved in a repetitive and semicircular motion. During administration of IPL, spontaneous movements of the legs continued. Immediately after administration of five IPL pulses, the temperature of the slide increased from room temperature to 49°C. Immediately afterward, the Demodex mite became completely immobilized. The legs appeared retracted, smoother, less corrugated, bulkier, and less well-defined. Movement of the Demodex mite was not observed at the hourly inspections for 5 h and after 24 h following the application of IPL pulses. Conclusions: Our video directly demonstrates the effect of IPL on a live Demodex mite extracted from a freshly epilated eyelash. The results suggest that IPL application with settings identical to those used for treatment of DED due to MGD causes a complete destruction of the organism.

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., (© 2020 The Authors Ophthalmic & Physiological Optics © 2020 The College of Optometrists.)

Introduction: Parasitic infections of the eye are a major cause of ocular-surface diseases globally. While most infections are treatable, parasites can cause varying levels of damage mostly due to late diagnosis or misdiagnosis as a result of doctors' unfamiliarity with their characteristics of latency and crypsis, as well as lack of awareness by the patients., Case Reports: In this study, we present three cases of phthiriasis palpebrarum, thelaziasis, and ophthalmomyiasis, respectively. Two of the cases were treated at the clinic and did not recur. One patient refused treatment and was lost to follow-up., Discussion: By evaluating the natural histories, morphology, symptoms, clinical findings, and treatment of these parasitic diseases, we systematically analyzed several distinct and unique parasite characteristics, especially latency and crypsis. Furthermore, we have proposed specific examination techniques and methods as well as prevention and treatment strategies from these specific perspectives, aiming to prompt timely diagnoses and early interventions for these diseases by health care workers and improve the public's awareness of parasitic infections., Conclusion: Parasitosis on the ocular surface is a global infectious disease, and prevention strategies include maintaining personal and environmental hygiene and limiting contact with animals. We recommend that health care workers should enhance their ability to detect and diagnose these diseases while promoting the public's awareness of them in the context of our new perspectives., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

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.

Demodex parasites may cause skin and eyelash lesions by settling on the pilosebaceous unit. This parasite plays a role in the pathophysiology of acne in polycystic ovarian syndrome (PCOS). We aimed to examine the relationship between Demodex folliculorum and blood glucose control in patients with PCOS with skin and eyelash lesions. Forty-four patients with PCOS with skin lesions were enrolled in the study. At least two specimens were taken from the skin lesions using the standard method and at least six epilated eyelashes were taken from both eyes under a biomicroscope and evaluated using a light microscope. The demographic characteristics, body mass index (BMI) and clinical parameters of the patients were recorded. Demodex folliculorum was present at a rate of 59.1% in the skin lesions of the patients with PCOS, 40.9% in eyelash samples and 43.18% in both skin and lashes. Homeostasis model assessment of insulin resistance (HOMA-IR), glycosylated haemoglobin (HB A1c) concentrations, and BMIs were significantly higher in the patients who had D. folliculorum in skin samples than in those without ( p  = .010, p  = .007 and p  = .02). Impaired glucose regulation may explain the pathophysiology of the increased D. folliculorum presence in the skin lesions of patients with PCOS.Impact statement What is already known on this subject? Although several studies on Demodex folliculorum and PCOS have been conducted, we have not yet found a study that examines D. folliculorum parasites in the eyelashes and skin correlating with glucose regulation in PCOS. This study presents new information about the relationship between the presence of D. folliculorum and impaired glucose regulation in women with PCOS. What do the results of this study add? D. folliculorum is seen more commonly in skin lesions in patients with PCOS with impaired blood glucose regulation. What are the implications of these findings for clinical practice and/or further research? D. folliculorum is present in both skin and eyelash lesions in patients with PCOS. These lesions may be prevented by avoiding unregulated glucose levels and obesity. In future studies, the investigation of the resorption of D. folliculorum parasites in skin lesions with the continuation of normal glucose levels in patients with PCOS will reveal a more interesting linkage.

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., (© 2019 Wiley Periodicals, Inc.)

Purpose : To investigate and compare the effect of warm compresses on meibomian gland dysfunction and Demodex folliculorum blepharitis. Methods : Forty-two subjects (13 males, 29 females; mean age of 56.45 years) enrolled and completed the two-month warm compress treatment study. Three warm compress therapies were compared: Warm face cloth, MGDRx EyeBag® and OPTASE TM Moist Heat Mask. Subjects attended for four visits: baseline, two weeks, four weeks, and eight weeks. Subjective symptoms, osmolarity, non-invasive tear break-up time, ocular surface staining, Schirmer I test, meibum expressibility and clarity, and eyelash manipulation and epilation to assess for the presence of Demodex folliculorum , were measured at each visit. Results : Meibomian gland dysfunction, based on a composite score of meibum quality and expressibility, reduced significantly with the MGDRx EyeBag® and the OPTASE TM Moist Heat Mask ( p < .05). There was no significant difference in efficacy for treating meibomian gland dysfunction between the two devices ( p = .29). No improvement in meibomian gland dysfunction was detected with the warm face cloth. Only the OPTASE TM Moist Heat Mask significantly reduced the quantity of Demodex folliculorum over eight-weeks of treatment ( p = .036, only baseline to week eight significant p = .008). Symptoms and ocular surface staining improved significantly in all three groups ( p < .05). There was no significant change observed in osmolarity, non-invasive tear break-up time or Schirmer I test within each group ( p > .05, respectively). Conclusion : The MGDRx EyeBag® and the OPTASE TM Moist Heat Mask exhibited superior efficacy in treating signs and symptoms of meibomian gland dysfunction, compared to the use of a warm face cloth, over the eight-week period. The OPTASE TM Moist Heat Mask demonstrated dual therapeutic abilities, treating both meibomian gland dysfunction and Demodex folliculorum blepharitis. Repeated application of heat for the treatment of meibomian gland dysfunction may continue to present a good home-remedy option for patients.

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 ± 5.4 vs 15.2 ± 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., Competing Interests: Declaration of Competing Interest The study was conducted as part of a self-funded post-graduate research degree. The authors report no conflicts of interest and have no proprietary interest in any of the materials mentioned in the article. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Pthirus pubis, popularly known as crab louse, usually infests the pubis, groin, buttocks, intergluteal fold and perianal region. However, it can also infest, in particular in hairy males or when the infestation is longstanding, the thighs, abdomen, chest, axillae and face. The involvement of the scalp is very rare. Eyelashes may also be involved. We present a review of the literature about etiology, epidemiology, clinical features, complications and therapy of Pthiriasis of the eyelashes.

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)., (Copyright © 2020 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: To evaluate facial Demodex densities in participants with varying severities of blepharitis secondary to Demodex folliculorum assessed by the highest number of cylindrical dandruff on one lid., Methods: This double masked cross-sectional study included 58 participants [19 control, 21 mild/moderate and 18 severe Demodex blepharitis] who underwent a standardized skin-surface biopsy and a lash epilation for each lid to obtain the forehead Demodex densities and the overall lash mite count, respectively. Also, facial photographs were taken to evaluate facial erythema and dermatological conditions. The Ocular Surface Disease Index [OSDI], non-invasive break-up time [NIBUT], tear meniscus height [TMH], bulbar conjunctival redness as well as additional questions on watery eyes, ocular itching and itching along the lids were assessed., Results: Both mild/moderate and severe Demodex blepharitis groups were over the cut-off value [≥ 5 mites/cm 2 ] that confirms a facial demodicosis (mild/moderate: 5 ± 1; severe: 6 ± 1) while the control group was below it (2 ± 1). Thereby, group comparisons showed that an increased severity of Demodex blepharitis was associated with higher forehead mite densities (p = 0.002) and increased lash mite count (p < 0.001). The degree of facial erythema was also positively correlated with forehead mite densities (rs = 0.31, p = 0.02). When compared to the controls, the mild/moderate group had more watery eyes (X 2  = 6.54, p = 0.02), a lower TMH (U = 100.5, p = 0.006) and the severe group had more itching along the lids (X 2 = 4.94, p = 0.04). The other ocular signs and symptoms [NIBUT, bulbar conjunctival redness, OSDI] were not affected by the severity of Demodex blepharitis (p > 0.05)., Conclusion: Palpebral and facial Demodex infestation can co-exist, as the presence of blepharitis secondary to Demodex is associated with increased facial mite densities., Competing Interests: Declaration of Competing Interest SA has received honorarium for conferences/consulting from Allergan and Shire. EB has received funding from Alcon, Allergan, Canadian Optometric Trust Fund, I-Med Pharma Inc, Shire and honorarium for conferences/consulting from Akorn, Alcon, Allergan, American Academy of Optometry, Canadian Association of Optometry, CooperVision, Labtician, Jobson Publishing, Novartis, Santen, Shire., (Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Demodex folliculorum shows a high occurrence in the general population, however, its pathologic relevance is still controversial. In this prospective study, we evaluated the prevalence of D. folliculorum on eyelashes from 8,033 subjects of a university population (including 7,782 students, and 251 academics). Additional information on some risk factors to infection by the mites was evaluated, as well. A prevalence of 1.47% was found, where 118 individuals were positive for D. folliculorum; and, among them, 63 (53.4%) were women and 55 (46.6%) were men. Results showed a negative correlation with the age (r = -0.45), the highest prevalence was found in individuals between 19 and 22 years of age (2.1%, 84 patients). The number of D. folliculorum mites did not differ between the right and left eye; however, the use of cosmetics or facial cream, contact lens, hair removers, were factors present in patients infected with D. folliculorum. Although Demodex prevalence did not increase in line with weight, we found significantly higher prevalence in the 51-60 kg and 71-80 kg weight groups, and a particularly high prevalence in the over 81 kg weight group (2.6%). In conclusion, it was observed that the main population positive to infection consisted of young adults; this is in contrast with the international evidence reporting a high rate of infection in older adults. Besides, our results suggest that items of daily use such as cosmetics, facial cream, eyeliner, glasses, or contact lenses may be some of the main culprits of the infection by D. folliculorum.

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.

Objective: To determine whether ocular Demodex colonization results in differences in Schirmer test scores and Ocular Surface Disease Index (OSDI) questionnaire values in individuals with dry eye disease (DED) diagnosed for the first time., Method: Eighty-eight adults aged 40 to 68 years who were admitted to Ophthalmology outpatient clinic for routine ophthalmological examination or presbyopia examination and diagnosed with DED for the first time and who do not have any chronic disease were included in the study. All the patients were asked to complete the OSDI, which is widely used for assessing dry eye symptom severity and vision-related functioning. The Schirmer test was performed, and then two eyelashes were taken from the inferior eyelids of each eyes. After saline (0.09% NaCl) was added to the sample, it was quickly taken to the microbiology laboratory, which is located next to the Ophthalmology policlinic. The sample was evaluated by a parasitologist experienced in Demodex., Results: One hundred sixty-eight eyes of 84 patients were included in the study. Average Schirmer test score was 2.1±0.5, the OSDI questionnaire score was 61.82±10.95, and the mean age was 55.36±8.74 years in patients who had Demodex colonization (n=30), whereas the average Schirmer test score was 6.6±0.9 score, OSDI questionnaire score was 40.96±12.73, and the mean age was 49.12±6.87 years in patients without Demodex colonization (n=58). It has been observed that dry eye patients with Demodex colonization had a higher mean age (P: 0.001), higher mean OSDI score (P: 0.001), and lower average Schirmer test score (P: 0.001) compared with those without Demodex. The significant relationship between lower Schirmer test score and higher OSDI rates and occurrence of Demodex infestation continued after adjusting for mean age values (P=0.012; P=0.035)., Conclusion: It was determined that the presence of ocular Demodex colonization was associated with the average Schirmer test scores, OSDI scores, and age values in patients with newly diagnosed DED. Demodex quantity was found increased in older aged patients, but the significant relationship between lower Schirmer test score and higher OSDI rates and Demodex infestation persisted even after controlling the mean age values. Supporting these findings with large-numbered and randomized-controlled studies will help in clarifying the association of the Demodex infestation with etiopathogenesis of dry eye.

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.

Purpose: The presence of Demodex species can be associated with blepharitis. Their pathogenic potential in meibomian gland dysfunction is discussed herein. The purpose of this study was to determine the prevalence of Demodex mites in eyelashes of Austrian patients with ocular discomfort and to evaluate associated changes of the lid margins and meibomian glands., Design: This is a case-control study., Methods: Two hundred twenty-nine consecutive patients with ocular discomfort from an Austrian dry eye clinic were investigated for the presence of Demodex mites on sampled eyelashes. Associations of a mite infestation with individual dry eye and lid parameters were assessed. Lid margins were evaluated for scales, vascularization, Marx line, expressibility and quality of meibum, and drop-out of meibomian glands., Results: Demodex mites were identified in 40.2% of patients suffering from ocular discomfort (mean mite count 3.3 ± 2.9 per patient). Infestation with mites was associated with the presence of significantly more cylindrical scales (sleeves), a higher Marx line score, and a lower quality of meibum compared with mite-free patients. There were no significant associations with the expressibility and the drop-out of meibomian glands., Conclusion: The prevalence of Demodex mites in patients with ocular discomfort is high. The mean mite count per patient in this Austrian dry eye unit population is lower compared with previously published data from Asian regions. The infestation of the eyelids with Demodex species is associated with changes of the anterior and posterior lid margin, suggesting a pathogenic role in blepharitis and meibomian gland dysfunction., (Copyright © 2019 Elsevier Inc. All rights reserved.)

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., (Copyright © 2019 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: To evaluate the ocular surface characteristics and the infestation of Demodex in Chinese paediatric and adult blepharokeratoconjunctivitis (BKC)., Methods: Fifty consecutive patients with BKC and 50 age- and sex-matched healthy subjects were enrolled. Lid margin characteristics and corneal disorders were evaluated under slit-lamp illumination. Four eyelashes were collected from each eye to examine Demodex infestation by light microscopy., Results: Corneal neovascularization (P = 0.001) and scarring (P = 0.040) were significantly worse in children than in adults with BKC, whereas meibum quality was worse in adults (P = 0.008). Diagnosis delay was longer in children with BKC than in adults (2.2 vs 1.2 years, P = 0.022). Demodex infestation was more frequent in subjects with BKC than in healthy subjects (56% vs 26%, P = 0.002). The lid margin inflammation and meibomian gland dysfunction were worse in Demodex-positive subjects than in Demodex-negative subjects with BKC., Conclusions: Children with BKC had severer corneal disorders compared with adult BKC patients, which may be caused by a long-delayed diagnosis. Ocular demodicosis was more common in subjects with BKC. Ocular Demodex infestation was associated with worse lid margin inflammation and meibomian gland dysfunction.

Purpose: To evaluate the clinical efficacy of Lumenis® M22 TM intense pulsed light (IPL) in reduction of ocular Demodex infestation in eyelashes in a prospective study., Methods: Forty patients with ocular demodicosis were recruited. Then half were randomly picked to receive the IPL treatment, while the other half got 5% tea tree oil (as the control group). Demodex counts, the ocular surface disease index (OSDI) score, lid margin abnormalities, conjunctival congestion, tear break-up time (TBUT), corneal staining with fluorescein, meibomian gland (MG) expressibility, meibum quality, modified Schirmer I test with anaesthetic (SIT), were assessed on the day before treatment and after treatment of 30 and 90 days, respectively. Changes in the parameters were compared between the IPL group and the control group on the days after treatment of 30 and 90 days., Results: No differences were observed in Demodex counts, lid margin abnormalities, conjunctival congestion, corneal staining with fluorescein, MG expressibility, SIT in the two groups on the days after treatment of 30 and 90 days (p > 0.05), whereas there was a statistically significant difference in the OSDI score, TBUT, meibum quality (p < 0.05). The Demodex eradication rate was more thorough in the IPL group (100%) than in the control group (75%)., Conclusions: IPL shows the preferably therapeutic potential for ocular Demodicosis.

Purpose: To investigate the prevalence of ocular Demodex folliculorum (DF) in an Irish population. To validate a modified Ocular Surface Disease Index questionnaire and employ it to evaluate the relationship between dry eye symptoms and the presence of DF., Methods: One hundred and fifty-six subjects were enrolled in an epidemiological cross-sectional prevalence study. Each subject completed a novel questionnaire on ocular symptoms and was assessed for the presence of DF. Data was analysed to assess prevalence and to search for significant links between each symptom and DF., Results: An overall prevalence of 68% was found. Total mean number of DF found on microscopic examination was 3.83 mites per subject (range 0-25). The presence of symptoms was higher among individuals with DF (P = 0.04). Itch was found to be the symptom most significantly associated with the presence and number of DF (P = 0.025 and P = 0.035, respectively). The questionnaire showed good internal consistency (Cronbach's alpha; α > 0.7) and good reliability (Intra-class Correlation Co-efficient; ICC > 0.7). The sensitivity and specificity of a positive symptom result using the questionnaire were 70.8% and 46.9%, respectively., Conclusion: There is a strong association between the prevalence of DF and symptoms, in particular itchy eyes. However, not all patients with DF will be symptomatic. The newly developed questionnaire is a reliable instrument for measuring change in symptoms over a period of time and suitable for observing patient reported outcomes in interventional treatment studies.

Chronic blepharitis is an ocular disease frequently encountered by ophthalmologists. Demodex mites can play a role in the pathogenesis of blepharitis along with bacterial agents, especially in treatment-resistant cases or recurrent cases after treatment. This study was performed to determine the prevalence and load of Demodex folliculorum (Simon) and Demodex brevis Akbulutova in chronic blepharitis patients and to assess the relationship between the prevalence and load of Demodex species and ocular symptoms. The study included 365 patients diagnosed with chronic blepharitis in clinical examination, and 175 controls without any chronic or ocular disease. In the study, two eyelashes were sampled from the lower and upper lids of the right and left eyes (a total of eight samples) of the participants. Eyelash samples were examined under a light microscope, and Demodex species were identified and counted. Demodex were detected in 79.2% (95% CI: 75-83%) of patients and 31.4% (95% CI: 24-38%) of controls in this study. D. folliculorum alone (mean: 4.96; min: 1; max: 17; P < 0.001) was detected in 72.3% of patients, in 0.7% D. brevis alone (mean: 1.00, P > 0.05), and in 27% both D. folliculorum and D. brevis (mean: 21.65; min: 2; max: 79; P < 0.001). In Demodex positive controls, only D. folliculorum (mean: 2.38; min: 1; max: 6) was detected while there was no D. brevis. Nevertheless, mean ocular symptom scores were significantly higher in Demodex positive patients than in Demodex negative patients (P < 0.001). Itching, foreign body sensation, and redness were the most common complaints in Demodex positive patients. As a result, Demodex mites were high in numbers in patients with chronic blepharitis in Erzincan. There was a positive correlation between Demodex mites and chronic blepharitis and ocular symptoms. It may be helpful to consider these findings in clinical assessment of blepharitis patients.

Purpose: To compare the in vitro antiparasitic effects of MGO ™ Manuka honey and tea tree oil against ocular Demodex., Methods: Fifty-two viable Demodex mites were acquired from the epilated eyelashes of 9 participants with blepharitis and symptomatic dry eye. Viable mites were randomised to one of five treatment groups: cyclodextrin-complexed and uncomplexed Manuka Honey, 100% and 50% tea tree oil, and no treatment. Following treatment application, mite viability was assessed for 240 min, based on limb and body movement and/or the development of a crenated/translucent appearance. Kaplan-Meier survival analysis was then performed., Results: The log-rank test demonstrated a significant treatment effect on the survival distribution of Demodex mites (p < 0.001). Bonferroni-corrected post-hoc pairwise analysis showed that all treatments except for uncomplexed honey effected lower survival probabilities than the untreated group (all p < 0.001). Among the four treatments, survival probabilities were lowest with 100% tea tree oil (all p < 0.001), and highest with uncomplexed honey (all p ≤ 0.001). No difference was observed between complexed honey and 50% tea tree oil (p = 0.81)., Conclusions: The in vitro efficacy of cyclodextrin-complexed Manuka honey was comparable with 50% tea tree oil, an established treatment for ocular Demodex. The findings support future clinical trials investigating the therapeutic effects of complexed honey in demodectic blepharitis patients., (Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To compare the in vitro anti-demodectic activity of four commercially available dedicated eyelid cleansers (Cliradex ® towelette cleanser, Oust™ Demodex ® cleanser, Blephadex™ eyelid foam, TheraTears ® SteriLid ® eyelid cleanser), tea tree oil, undiluted terpinen-4-ol and linalool; and to assess the terpinen-4-ol content of the commercial cleansers and tea tree oil., Methods: In vitro anti-demodectic efficacy assessment: 93 viable Demodex mites were acquired from the epilated eyelashes of 10 participants, and were randomised to application with one of the four eyelid cleansers, 100% and 50% tea tree oil, undiluted terpinen-4-ol and linalool, or no treatment. Following treatment application, mite viability was assessed for 300 min, based on limb/body movement and/or the development of a crenated/translucent appearance. Kaplan-Meier survival analysis was then performed., Mass Spectrometry Analysis: The absolute concentration of terpinen-4-ol and the relative abundance of linalool in the four eyelid cleansers and tea tree oil were determined., Results: In vitro anti-demodectic efficacy assessment: No significant differences were observed between undiluted tea tree oil, terpinen-4-ol and linalool (all p > 0.05). Although all commercial eyelid cleansers effected lower mite survival probabilities than the untreated group, Cliradex ® was the only eyelid cleanser that demonstrated comparable antiparastic activity to 50% tea tree oil (p = 0.36)., Mass Spectrometry Analysis: Among the four eyelid cleansers, Cliradex ® contained the highest concentration of terpinen-4-ol, while linalool was present in TheraTears ® SteriLid ® only., Conclusions: Of the four commercial eyelid cleansers, Cliradex ® demonstrated the highest levels of in vitro anti-demodectic activity and terpinen-4-ol content. Undiluted linalool and terpenin-4-ol showed comparable antiparasitic efficacy, and the use of linalool in the management of demodectic blepharitis warrants further investigation., (Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: Two Demodex species (eyelash mites)-D. folliculorum and D brevis-are believed to be associated with human skin and eye diseases. However, the clinical significance of infection with Demodex species remains controversial., Study Design: The aim of this study was to estimate the prevalence of ocular demodicosis in patients with blepharitis as compared with the prevalence in the healthy population in Poland., Methods: This case-control prospective study was carried out from 2007 to 2016. The enrolled patients (668) were divided into 2 groups: the study group, comprising 553 patients with blepharitis (349 women and 204 men, aged 17-88 years), and the control group, comprising 115 healthy volunteers without a history of ocular pathologies (78 women and 37 men, aged 17-88 years). A sample of 10 eyelashes was taken aseptically from each eye of the examined person and later studied under a light microscope., Results: Demodex species were found in 62.4% (345/544) of the patients in the study group and in 24.3% (28/100) of the controls (P = .001, OR = 0.006). The overall prevalence was 55.8% (373/668) in all the examined participants. The presence of Demodex infection increased with age in both groups. No association of Demodex infection with gender was found (119/204 vs 226/349; P > .05, OR 1.086). A high mean number of mites was present more frequently in patients aged older than 50 years and in those who complained especially about itching (P < .05)., Conclusion: The prevalence of ocular demodicosis is significantly correlated with blepharitis and increases with age.