ABSTRACT
Purpose@#To determine the effectiveness of lid scrub with petroleum jelly versus lid scrub with tea tree oil and tea tree facial wash in patients with symptomatic blepharitis associated with above-normal Demodex counts@*Methods@#Patients with symptomatic anterior blepharitis (AB), meibomian gland dysfunction (MGD), or mixed blepharitis (MB) were recruited into the study. Pertinent data, including ocular symptoms and findings, were recorded. Digital photographs of the lid margins were taken. Lash sampling was done using the modified Coston method for lash epilation. Patients with below-normal Demodex counts (DC <5) were excluded while those with DC ≥5 were randomly assigned to one of either treatment regimen: (1) lid scrub with tea tree oil and tea tree facial wash (The Body Wash®, control group), or (2) lid scrub with petroleum jelly (Apollo Pure Petroleum Jelly®, study drug). Lid scrub with the tea tree oil (TTO) or petroleum jelly was administered at the clinic during the initial visit and at 2-week intervals thereafter for 6 weeks. Patients were instructed to apply tea tree (TT) facial wash or petroleum jelly at home on specified intervals daily. DC posttreatment was recorded, and digital photographs of the eyelids were taken at the end of treatment.@*Results@#Thirteen patients were included in the study; 5 in the TTO and 8 petroleum jelly. In the TTO group, 3 patients had decrease in DC and 2 an increase, but all patients reported decrease in the severity and frequency of ocular symptoms. In the petroleum jelly group, 5 patients had decrease in DC after 6 weeks, while the remaining 3 had opposite results. All reported a general improvement in their symptoms. No adverse reactions were observed in either treatment groups.@*Conclusion@#Lid scrub with petroleum jelly caused a significant reduction (p<0.05) in Demodex counts compared to lid scrub with tea tree oil and tea tree facial wash. Petroleum jelly may have some effect in the eradication of Demodex mites in cases of Demodex-induced blepharitis. Although lid scrub with petroleum jelly and tea tree oil and tea tree facial wash both produced a decrease in Demodex counts and a decrease in the frequency and severity of ocular symptoms after 6 weeks of treatment, the presence of some conflicting results suggests that further studies with more patients should be initiated.
Subject(s)
Meibomian Gland Dysfunction , Petrolatum , Tea Tree OilABSTRACT
Objective@#This study determined the incidence and density of Demodex species on the eyelashes of subjects with normal eyelids, anterior blepharitis (AB), meibomian-gland dysfunction (MGD), and mixed blepharitis (MB).@*Methods@#Consecutive patients diagnosed with AB, MGD, and MB were recruited, along with 50 normal individuals who served as controls. All underwent a standard eye exam. Data on demographics and ocular symptomatology were gathered. Digital photographs of the lid margins were taken. Lash sampling was done using the modified Coston procedure for epilating lashes. The collected lashes were checked for Demodex based on morphology and motility, and the total number of Demodex identified were tabulated for each eye. Patients with AB and MB had eyelid bacterial culture. Data were subjected to statistical analyses. @*Results@#A total of 167 patients with mean age of 53.7 years were included: 40% with MGD, 12% with AB, 19% with MB, and 30% normal. The overall incidence of Demodex infestation was 73%; 85% for MGD, 95% for AB, 97% for MB, and 34% for control group. The mean density count (MDC) was 13.63 for MB, 8.95 for AB, 4.08 for MGD, and 0.98 for the normal group. The incidence and density of Demodex infestation increased with age. Symptoms of irritation correlated with high MDC (>9 mites) (p <0.04). Asymptomatic patients had low MDC (0 to 2 mites) (p < 0.01). Sixty-eight percent of patients with cylindrical dandruff (p <0.001) and 36.1% with plugged meibomian glands (p < 0.001) had high MDC, while 82.7% with no eyelash findings had low MDC (p < 0.001). @*Conclusion@#The incidence and density of Demodex infestation was highest among patients with AB and MGD. Lid irritation and presence of cylindrical dandruff were indicative of high density count. These should alert the clinician to treat concomitant Demodex infestation of the eyelashes.