ABSTRACT
PURPOSE: Demodex folliculorum and Demodex brevis are ectoparasites with an astounding prevalence of 100% in patients aged 70 years and older. Every person in this age group is estimated to carry a colony of 1000 to 2000 mites. With such a high prevalence, little attention has been paid to the mite among eye care practitioners. We demonstrate a clinical sequence in a set of case reports to identify the mite. The clinical sequence includes a clinical history of blepharitis, dry eyes, and/or ocular allergy; slit lamp examination of cylindrical dandruff; and confirmation using light microscope evaluation of epilated lashes. CASE REPORTS: Patient 1 was a 68-year-old woman who demonstrates associations with dry eyes and diabetes. Patient 2 was a 44-year-old man with uncommonly seen D. brevis present. Patient 3 was a 40-year-old woman with dry eyes and allergy, showing mite tails protruding from base of lashes. Patient 4 was a 60-year-old woman who demonstrates the association with rosacea. Patient 5 was a 53-year-old woman intermittently taking topical steroid and antibiotic combination medications, with an actual mite photographed on the surface. CONCLUSIONS: Following a clinical sequence helps identify Demodex, the underdiagnosed, undertreated, and underappreciated ocular surface disease.
Subject(s)
Blepharitis/diagnosis , Dry Eye Syndromes/diagnosis , Eye Infections, Parasitic/diagnosis , Eyelashes/parasitology , Mite Infestations/diagnosis , Mites , Adult , Aged , Animals , Blepharitis/parasitology , Dry Eye Syndromes/parasitology , Eye Infections, Parasitic/parasitology , Female , Hair Follicle/parasitology , Humans , Male , Meibomian Glands/parasitology , Meibomian Glands/pathology , Middle Aged , Mite Infestations/parasitologyABSTRACT
The ubiquitous skin mite Demodex has been implicated as an instigator of anterior blepharitis. To date, overpopulation of the organism has been verified by cilia epilation (Coston or modified Coston method). This monograph describes an alternate technique to isolate Demodex organisms by eyelash rotation within the follicle. Via this method, without epilation, mites are made visible in follicles that may or may not display the cylindrical cuffing characteristic of demodicidosis.
Subject(s)
Diagnostic Techniques, Ophthalmological , Eye Infections, Parasitic/diagnosis , Eyelashes/parasitology , Hair Diseases/diagnosis , Hair Follicle/parasitology , Mite Infestations/diagnosis , Mites , Animals , Blepharitis/diagnosis , Blepharitis/parasitology , Eye Infections, Parasitic/parasitology , Hair Diseases/parasitology , Hair Removal , Humans , Mite Infestations/parasitologyABSTRACT
Floppy eyelid syndrome (FES), a clinically recognized condition of lax and rubbery eyelids, is commonly under-diagnosed. It is associated with chronic papillary conjunctivitis and is often, although not always associated with obesity and obstructive sleep apnea. Symptoms of FES mimic those of ocular surface disease; indeed FES itself can contribute to ocular surface damage. Diagnostic signs of FES can include foreign body sensation, ocular discharge, injection, and eyelid and eyelash ptosis. Palliative topical measures may be inadequate for symptomatic relief necessitating surgical eyelid repair.
