Palpebral and facial skin infestation by Demodex folliculorum.

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/cm2] 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 (X2 = 6.54, p = 0.02), a lower TMH (U = 100.5, p = 0.006) and the severe group had more itching along the lids (X2 = 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.

Automated Ocular Surface Image Analysis and Health-Related Quality of Life Utility Tool to Measure Blepharokeratoconjunctivitis Activity in Children.

PURPOSE: To explore the tolerability of automated conjunctival hyperemia quantification in children with blepharokeratoconjunctivitis (BKC) and its agreement with clinical activity grading and to explore the Children's Health Utility 9D (CHU9D) as a measure of health-related quality of life in children with BKC. METHODS: We enrolled 63 children, 31 with BKC and 32 without ocular surface inflammation, with a median [interquartile range (IQR)] age of 10.6 (7.2-13.9) years for BKC and 11.4 (9.5-13.8) years for healthy volunteers. Two masked observers graded the ocular surface images. The children indicated discomfort during imaging on a 5-point Likert scale. Using nonparametric tests, we explored the interobserver agreement and the agreement of automated redness index (RI) measurements of limbal and bulbar conjunctival hyperemia with clinician assessment. The children also completed the 9-item CHU9D. RESULTS: The children tolerated imaging well: median (IQR) Likert value of 0 ("comfortable") (0-0) in healthy volunteers and 1 ("a little bit uncomfortable") (0-2) in mild/moderate BKC. In children with BKC, the median (IQR) bulbar RI was 1.3 (0.8-1.6) and the median limbal RI was 0.7 (0.3-1.1). In healthy volunteers, the median bulbar RI was 0.8 (0.55-1.1; P = 0.162) and the median limbal RI was 0.3 (0.2-0.4; P = 0.02). The agreement between RI and clinical grading was high. There was no significant difference between the mean CHU9D utility score between the 2 groups [0.89 (SD 0.08) vs. 0.92 (SD 0.07); P = 0.15]. CONCLUSIONS: Automated conjunctival hyperemia quantification is feasible in children with ocular surface inflammation and may prove useful for long-term monitoring and as an objective outcome measure in clinical trials.

Development and evaluation of a measure of patient-reported symptoms of Blepharitis.

BACKGROUND: Blepharitis is an ocular surface disease and chronic ophthalmic condition. This paper reports on the development of psychometric evaluation of a patient-reported measure of blepharitis symptoms. METHODS: Self-reports of 13 blepharitis symptoms collected in a Phase 3 multi-site, randomized, double-masked, 4-arm parallel group, clinical trial of 907 individuals with blepharitis (mean age = 62, range: 19-93; 57% female) were analyzed. Symptoms asked about were: eyes that itch; eyes that burn; eyelids feel heavy or puffy; feel like something is in your eye; dry eyes; gritty eyes; irritated eyes; eyes that tear or water; crusty eyes; flaking from your eyelids; eyelids that are stuck together; red eyes or eyelids; and debris like pieces of skin or dandruff in your eyes. RESULTS: Categorical factor analyses provided support for two multi-item symptom scales: Irritation (9 items, alpha = 0.88) and Debris (4 items, alpha = 0.85). Spearman-rank order correlations of the Irritation and Debris scales with the Ocular Surface Disease total score were 0.63 and 0.41, respectively (p's < 0.001). Rank-order correlations between ratings of clinicians and self-reports of puffy eyes (r = 0.07, p < .05), red eyes (r = 0.12, p < .001), debris (r = 0.03, p > 0.05), and irritation (r = 0.47, p < .001). CONCLUSIONS: This study provides support for the psychometric properties and construct validity of the Irritation and Debris scales for assessing symptoms of blepharitis. The associations between the self-reports and clinician ratings of 4 symptoms indicate substantial unique information in the new self-reported symptom items. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov under the registry number NCT01408082 .

Ojo seco y salud mental / Dry eye and mental health

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