Distiquíases em gatos / Distichiasis in cats

Background: Distichiasis is a disease that is rare in cats, but very common in dogs. The term distichiasis may be controversial when used in the feline species, given that they do not possess true cilia, but rudimentary hair along the superior palpebra. The patients may be asymptomatic, though some show signs of ocular discomfort and ulcerative keratitis. The diagnosis is reached through an ophthalmological exam, and the treatment consists of the removal of the cilium with or without its hair follicle. With this work, we aim to report a series of cases of distichiasis in cats, as it is an uncommon anomaly, and has the potential to cause ocular discomfort in cats. Cases: Two mobile services of veterinary ophthalmology, one in the federal district of Brasília (DF) and the other in the municipality of Valinhos (SP), attended to 9 cats over a period of 5 years (2018 to 2022). The cats (n = 9) attended are of an undefined breed with ages varying from 10 months to 9 years, with an average of 3.9-year-old. The number of distichiasis presented by the animals was classified according to their quantity, being categorized as a mild grade when there was a single cilium, moderate grade when there were 2 to 4 cilia, and severe grade when there were more than 5 cilia. The highest incidence of distichiasis in this study was in males (78%) while females accounted for (22%) of the cases. The clinical changes reported by the owners consisted of signs of ocular discomfort (photophobia, blepharospasm, and periocular itching), ocular discharge and ocular redness. In the ophthalmological evaluations, blepharospasm (22%), serous to mucosal secretion (56%), chemosis (22%), mild (44%) to moderate (11%) conjunctival hyperemia, and ulcerative keratitis (22%) were observed. Distichiasis was more frequent affecting both eyes (56%), while in only (44%) of cases it affected the left eye only. The highest occurrence of cilia was identified in the upper palpebra (78%). Distichiasis was found more often in the temporal palpebral portion (78%), and in 2 patients the identification was more challenging since these cilia lack pigmentation. Single cilium affected (44%) of patients, while 5 cats had multiple distichiasis (56%). A total of 29% of the cats had a mild grade, whereas 14% had a moderated grade, and 57% had a severe grade. The treatments performed consisted of manual epilation (ME) and electroepilation (EE). ME was carried out in 56% of the cats, with relapses occurring in 80% of the patients, while 44% of the cats submitted to EE had a relapse in 20% of the cases. Discussion: Distichiasis is an inherited disorder very frequent in dogs, but considered uncommon in cats. Its causative factor is still unknown, as is its mode of inheritance. In distichiasis therapy, epilation, electroepilation, electrolysis, diode laser, cryotherapy and surgical palpebral resection techniques are referred to as procedures. Among the treatments used in this study, we observed a lower incidence of relapse with the electroepilation technique, which proved to be a viable and successful therapeutic modality. This series of cases shows that perhaps this disorder is much more frequent than what has been reported in the literature, being sometimes underdiagnosed and consequently underreported. Therefore, distichiasis in cats should be considered as a differential diagnosis in patients with clinical signs of ocular discomfort and ulcerative keratitis.

Scanning electron microscopy of panitumumab-induced eyelash and hair alterations - Pili canaliculi.

Panitumumab is a monoclonal antibody against the epidermal growth factor receptor used in metastatic colorectal cancer; in addition to tumor cells, it acts on epidermal keratinocytes and on the outer root sheath and presents skin toxicity in up to 90% of cases. A scanning electron microscope was used to examine the eyelashes and hairs of a 65-year-old patient with eyelash trichomegaly, curly hair, and paronychia undergoing treatment with panitumumab. Grooving in the hair shafts were identified, which were more evident in the eyelashes. Similar to oral epidermal growth factor inhibitors (erlotinib and gefitinib), panitumumab can cause acquired pili canaliculi.

Safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to demodex infestation: A randomized, controlled, double-masked clinical trial.

PURPOSE: To evaluate the safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to Demodex infestation compared to vehicle control. METHODS: In this phase II, randomized, controlled, double-masked clinical trial, 60 eligible participants with Demodex blepharitis were randomly assigned in a 1:1 ratio to receive either topical lotilaner ophthalmic solution, 0.25% (Tarsus Pharmaceuticals, Inc., Irvine, CA) (study group) or the vehicle without lotilaner (control group) bilaterally twice a day for 28 days. Participants were followed at Days 7, 14, 28, 60 and 90. The efficacy parameters were change in collarette grade and Demodex density at Day 28. Safety parameters were adverse events, changes in corrected distance visual acuity (CDVA), intraocular pressure (IOP) and slit-lamp biomicroscopy. RESULTS: The study group showed a statistically significant decrease in collarette grade compared to the control group beginning at Day 14 (p = 0.003) in the upper eyelid and at Day 28 (p = 0.003) in the lower eyelid. Decreases in both lids were maintained through Day 90 (p < 0.001). At Day 28, mite eradication was achieved in 66.7% and 25.9% of eyes in the study and control group (p = 0.005); at Day 90, these proportions were 68.2% and 18.5% (p = 0.001), respectively. No serious adverse events or clinically significant changes in CDVA and IOP were observed. CONCLUSION: For Demodex blepharitis, treatment with lotilaner ophthalmic solution, 0.25% for 4 weeks is safe and effective. The improvement in collarette grade and mite density observed during the treatment period persisted for at least two months following treatment cessation.

Collarette Elimination and Demodex Mite Eradication with Topical Lotilaner Ophthalmic Solution, 0.25.

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.

The role for intra-arterial chemotherapy for refractory retinoblastoma: a systematic review.

BACKGROUND: Intra-arterial chemotherapy is a new retinoblastoma treatment associated with high rates of globe salvage that has been widely adopted for primary treatment of retinoblastoma but is less frequently used as secondary treatment for refractory retinoblastoma. This systematic review aims to summarize the reported outcomes of intra-arterial chemotherapy for refractory retinoblastoma. METHODS: We conducted a systematic review of studies published on PubMed, Medline, and Embase from 2011 to 2021 reporting globe salvage rates following intra-arterial chemotherapy for secondary treatment of refractory retinoblastoma. RESULTS: Our search yielded 316 studies, and 24 met inclusion criteria. The 24 included studies were comprised of 1366 patients and 1757 eyes. Among these, 1184 (67%) eyes received secondary indication treatment, and globe salvage was achieved for 776 of these 1184 eyes (64%). Sixteen studies reported cannulation success rates from 71.8 to 100%. Pooled analysis of subjects revealed 21 patients (2.6%) with metastatic disease and 26 deaths (3%) during study follow-up periods (7-74 months). The most common ocular complications were vitreous hemorrhage (13.2%), loss of eyelashes (12.7%), and periocular edema (10.5%). The most common systemic complications were nausea/vomiting (20.5%), neutropenia (14.1%), fever (8.2%), and bronchospasm (6.2%). CONCLUSIONS: Intra-arterial chemotherapy is associated with high rates of globe salvage and low rates of serious complications in patients with refractory retinoblastoma. Unfortunately, current literature is predominantly comprised of retrospective case studies, and further high-quality evidence is necessary to inform clinical practice.

Prevalence and risk factors to Demodex folliculorum infection in eyelash follicles from a university population of Mexico.

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.

Prevalence of Demodex spp. in eyelashes of a university's population in Santiago, Chile. / Prevalencia de Demodex spp. en pestañas de una población universitaria en Santiago, Chile.

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).

Ocular demodicosis: A review. / Demodicosis ocular: una revisión.

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.

Eyelash hair transplantation with strip composite eyebrow graft: an enhancing technique in tarsoconjunctival flap eyelid reconstruction procedure.

Purpose: To describe and evaluate the eyelash transplantation with strip composite eyebrow graft to improve eyelid anatomy in tarsoconjunctival flap eyelid reconstruction procedure. Methods: Twenty two patients with eyelid tumors managed by local excision and reconstruction using tarsoconjunctival flap reconstruction procedure were included. Eyelash graft was performed during flap division by harvesting a graft from the eyebrow and creating a recipient pocket in the receptor eyelid. Patients had a 1-year follow up. Eyelash orientation and follicle survival rate were recorded. Demographic variables were analyzed with descriptive statistics. For eyelash follicles survival rate assessment, we evaluated the number of follicles found in the first postoperative day with the follicles found at the end of the study using the Wilcoxon signed rank test. P < 0.05 was considered statistically significant. Results: All eyelash grafts showed a good follicle orientation and no cases of eyelashes misdirection toward the eyeball were reported. No statistical differences (p > 0.05) were found in Wilcoxon signed rank test when comparing the number of follicles present at the first postoperative day and the number of follicles present at the 12th postoperative month, meaning that the vast majority of follicles survived at the end of the study. Graft ischemia, necrosis or infection were not observed. Conclusions: Tarsoconjunctival flap is an outstanding option for eyelid reconstruction and eyelash transplantation with an eyebrow composite graft is an excellent procedure to enhance and recreate a normal eyelid.

Ácaros del género Demodex: ¿parásitos colonizadores de personas sanas o asociados a patología ocular? / Demodex genus: colonizing parasites of healthy people or mites associated with ocular pathology?

Las especies Demodex folliculorum y Demodexbrevis, responsables de la demodicosis humana, afectan la piel y en ocasiones están vinculadas con afecciones oculares. El objetivo de este trabajo fue conocer si existe asociación significativa entre la presencia del ácaro y de patologías palpebrales, y el papel de factores como la edad y el sexo de los pacientes. Se analizaron las pestanas de un conjunto de pacientes sintomáticos y asintomáticos (n = 72) de entre 9 y 82 años. El 53% de los pacientes fueron positivos para la presencia del ácaro Demodex. De ellos, el 66% manifestó síntomas o patologías oculares, dentro de las cuales la blefaritis y el ojo seco resultaron prevalentes. Se observaron asociaciones significativas tanto entre la presencia de este ácaro y una edad mayor de 60 años (p < 0,001), como entre la presencia del ácaro y ojo seco o blefaritis o ambos (p <0,001). Consideramos necesaria la búsqueda de Demodex sp. en pacientes con síndrome de ojo seco o blefaritis, especialmente durante la inmunosenescencia, a fin de instaurar tratamientos antiparasitarios específicos.

Demodex folliculorum and Demodex brevis are mites that are responsible for human demodicosis affecting skin and frequently linked to ocular diseasess. The aim of this work was to determine the association between Demodex sp. and eyelid and eyelash diseases and to establish the predisposing factors for acquiring this parasitic disease. Eyelashes from symptomatic and asymptomatic patients (n = 72) between 9 and 82 years old were analyzed, where 53% were positive for Demodex sp., of which 66% manifested ocular symptoms and pathologies, blepharitis and dry eye being prevalent. Significant correlations between Demodex and patients over 60 years of age (p <0.001) and between Demodex sp. and dry eye patients / blepharitis (p <0.001) were observed. We consider that it is necessary to search for Demodex sp. especially in those patients suffering from dry eye and blepharitis and/or during immunosenescence in order to implement specific antiparasitic treatments.

[Demodex genus: colonizing parasites of healthy people or mites associated with ocular pathology?] / Ácaros del género Demodex: ¿parásitos colonizadores de personas sanas o asociados a patología ocular?

Demodex folliculorum and Demodex brevis are mites that are responsible for human demodicosis affecting skin and frequently linked to ocular diseasess. The aim of this work was to determine the association between Demodex sp. and eyelid and eyelash diseases and to establish the predisposing factors for acquiring this parasitic disease. Eyelashes from symptomatic and asymptomatic patients (n=72) between 9 and 82 years old were analyzed, where 53% were positive for Demodex sp., of which 66% manifested ocular symptoms and pathologies, blepharitis and dry eye being prevalent. Significant correlations between Demodex and patients over 60 years of age (p<0.001) and between Demodex sp. and dry eye patients / blepharitis (p<0.001) were observed. We consider that it is necessary to search for Demodex sp. especially in those patients suffering from dry eye and blepharitis and/or during immunosenescence in order to implement specific antiparasitic treatments.

Interlamellar Autogenous Tarsal Graft for the Correction of Lower Eyelid Trichiasis Associated With Eyelid Margin Thinning.

PURPOSE: To evaluate the use of autogenous tarsal graft for surgical correction of lower eyelid trichiasis associated with eyelid thinning. METHODS: A total of 23 eyelids of 19 consecutive patients with trichiasis were operated with a variant of the Van Millingen procedure. The surgery consisted of interposing a 3-mm high fragment of autogenous ipsilateral upper eyelid tarsus corresponding to the trichiasis segment between the pretarsal anterior lamella and the lower tarsal plate. Preoperative assessment included quantification of eyelid thickness on the midpoint of the segment with trichiasis, biomicroscopy of the eyelid margin and location of the trichiasis. All patients were examined at 1, 3, 6, and 12 months after surgery. Eyelid thickness was measured at 1 month and 12 months of follow up. RESULTS: Preoperatively the mean thickness of the eyelid margin was 0.99 mm ± 0.06 standard error. One month postoperatively eyelid thickness increased to 2.08 ± 0.28 standard error, decreasing over time to reach 1. 48 mm ± 0.18 standard error 1 year after surgery, a value that did not differ from that of the control group. Small granulomas were diagnosed only in the early phases of the postoperative period. Trichiasis recurrence was seen in just 1 eyelid. Isolated abnormal lashes lateral or medial to the graft were present in 5 eyelids at the end of the study. CONCLUSIONS: Autogenous tarsal grafts placed parallel to the lower tarsus are a good option both to correct misdirected eyelashes and to restore normal lower eyelid thickness.