The effect of lid hygiene on the tear film and ocular surface, and the prevalence of Demodex blepharitis in university students.

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 ±â€¯5.4 vs 15.2 ±â€¯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.

The Clinical Use of Eyelash Manipulation in the Diagnosis of Demodex folliculorum Blepharitis.

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.

The Efficacy of Warm Compresses in the Treatment of Meibomian Gland Dysfunction and Demodex Folliculorum Blepharitis.

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 OPTASETM 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 OPTASETM 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 OPTASETM 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 OPTASETM 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 OPTASETM 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.

Ocular Demodex folliculorum: prevalence and associated symptoms in an Irish population.

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.

The efficacy of tea tree face wash, 1, 2-Octanediol and microblepharoexfoliation in treating Demodex folliculorum blepharitis.

PURPOSE: To compare the efficacy of Dr Organic Tea Tree Face Wash, OcuSoft Lids Scrub Plus and the BlephEx™ device at treating of Demodex folliculorum blepharitis. METHODS: Eighty-six subjects (33 males/36 females) were enrolled in a randomised controlled interventional treatment study. Subjects completed a dry eye symptom questionnaire and were assessed for presence of Demodex folliculorum. Subjects were divided into three groups according to treatment: Dr Organic Tea Tree Face Wash (A) (n=28), OcuSoft Lid Scrub Plus (B) (n=30), or in-house lid scrub with the BlephEx™ device before nightly lid scrubs with OcuSoft Lid Scrub Plus (C) (n=28). Subjects were advised to clean their eyelids nightly for four weeks. Each subject was re-assessed for symptoms and Demodex folliculorum blepharitis after two weeks and four weeks of treatment. RESULTS: The quantity of Demodex folliculorum was significantly reduced after four weeks of treatment in all three groups (p<0.05). Overall, there was no difference in efficacy between the three treatments (p>0.1). Symptoms reported by subjects were significantly improved after two and four weeks of treatment (p<0.05). Overall, there was no difference in efficacy between the three treatments to reduce symptoms after two or four weeks (p= 0.813 and p=0.646 respectively). CONCLUSION: All three methods tested have shown good ability to reduce Demodex folliculorum quantity, improve subjective symptoms and help treat Demodex folliculorum blepharitis.

The effect of previous soft contact lens wear on corneal refractive surgery outcomes.

PURPOSE: To examine the influence of previous soft contact lens (SCL) wear on corneal refractive surgery (CRS) outcomes when SCL wear is ceased for two weeks versus twenty-four hours, and also when compared to no wear, prior to CRS. METHODS: A retrospective examination of CRS patient records was carried out for two groups of patients- who ceased SCL wear for two weeks (n=45) and for twenty-four hours (n=49) prior to CRS and compared to a non-contact lens (NCL) control group (n=45 and n=49, respectively). CRS outcomes (efficacy, predictability, visual acuity and refractive error) were compared pre-operatively and one and six months post-operatively. RESULTS: One month post-operative results found unaided distance visual acuity (UDVA) was significantly better for LASEK/PRK patients who had ceased SCL wear for two weeks prior to CRS (-0.05±0.09), compared with the NCL group (0.02±0.09; p=0.04). Furthermore, six month post-operative results found UDVA was significantly better for both LASIK and LASEK/PRK patients who had ceased SCL wear for two weeks prior to CRS, and for LASEK/PRK patients who had ceased SCL wear for twenty-four hours prior to CRS compared with the NCL group. CONCLUSIONS: Given the current setup and methods followed, it was concluded that previous SCL wear had no negative impact on visual outcomes following CRS compared with a NCL control group, regardless of previous SCL cessation time prior to CRS.

The influence of soft contact lens wear and two weeks cessation of lens wear on corneal curvature.

INTRODUCTION: Accurate corneal measurements are crucial in corneal refractive surgery (CRS) to ensure successful outcomes. Soft contact lens (SCL) wear may result in changes to corneal curvature and structure. United States Food and Drug Administration (FDA) pre-operative guidelines recommend that prior to CRS, SCL wearers cease SCL wear for "at least two weeks before examination and treatment" [1]. Corneal curvature changes induced by SCL wear may take longer than two weeks to resolve. PURPOSE: To examine the effect of SCL wear on corneal curvature before and following two weeks SCL wear cessation. To explore the possible impact of different SCL materials and years of SCL wear. METHODS: Retrospective data analysis, between a group of SCL wearers (SCL: n=45); and a non-contact lens control group (NCL: n=45). Corneal curvature parameters were measured using the Pentacam (Oculus, Germany), before and following two weeks cessation of SCL wear. RESULTS: No significant differences in keratometry or Sagittal radius of curvature between SCL and NCL groups prior to or following SCL cessation. Tangential radius of curvature showed significant inferior steepening for the SCL group prior to SCL cessation (SCL vs. NCL; 7.77±0.30mm vs. 7.90±0.30mm; p=0.04). Following two weeks cessation of SCL wear this appeared to have resolved. CONCLUSIONS: Two weeks cessation of SCL wear appears sufficient for resolution of corneal curvature changes with modern SCL materials and years of SCL wear. However, further studies with longer lens deprivation periods are required to ensure stability for all SCL wearing patients.