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Demodex & Ocualr Disease
中Chung Shan Medical University Hospital
Attending ophthalmologist
LUO. KAI-SHIN
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Demodex spp.
Around 65 species of Demodex
Lives on humans: D. folliculorum and D. brevis
Primarily found in the face, near the nose, the eyelashes, and eyebrows, but also occur elsewhere on the body.
Introduction
D. fooliculorum
Follicuorum
0.3- 0.4mm
Hair follicles, Anterior blepharitis
Palopoli et al. BMC Genomics 2014, 15:1124
D. brevis
D. brevis
0.2- 0.3mm Sebaceous glands Posterior blepharitis
Dermatophagoides pteronyssinus ＶV.S Demdex spp.
Kingdom: Animalia
Phylum: Arthropoda
Subphylum: Chelicerata
Class: Arachnida
Order: Trombidiformes
Family: Demodecidae
Genus: Demodex
ＡTaxonomy
Anatomy
Life-cycle: 14–18 days; 3-4 weeks
Disease Presentation
Disease presentation
Can be found in asymptomatic patients
Prevalence: ↑ with age
84% of the general population aged 60 years
100% of the general population aged above 70 y/o
∼58% of individuals with mites will have evidence of chronic blepharitis
Xiaohui Luo, et al. Cornea 2017
Risk factors of ocular demodicosis Rosacea
Risk factors
Skin phototype
Sunlight exposure
Alcohol intake, smoking, stress
Hot beverages, spicy food
Abrupt changes in temperature Systemic immunocompromised status
Associated with external eye diseases
Eyelash loss
Abnormal eyelash alignment Blepharitis, conjunctivitis
Pterygium, chalazia
Meibomian gland dysfunction
Sight- threatening keratitis
Eyelid basal cell carcinoma
Associated Disease
telangiectasia
lid margin telangiectasia
plugging of gland orifices
lid margin irregularity
lid margin thickening
Pathogenesis
Carry concomitant bacteria on their surface
Carry Bacillus oleronius inside their abdomen
Proteins inside the mite and their debris/ waste trigger host inflammatory response
Bacteria
Staphylococcus epidermidis (95.8%) Propinibacterium acnes (92.8%) Corynebacterium spp. (76.8%)
Acinetobacter spp. (11.4%)
Staphylococcus aureus (10.5%)
Bacteria
Treatment
Treatment
ㄅ1. heat, warm packing
2. lid scrub, lid hygiene and ocular environment
3. Previous oral treatment: Crotamiton、etronidazole、Ivermectin、Permethrin
Tea Tree Oil
Oust Demodex
Ivermectin- Oral & Topical
Ivermectin
Soolantra
Topical
Laser therapy
1. PDL(Pulse dye laser)= Cynosure”Cynergy Laser: 585-595nm, reduced vascularity of lid margin
2. Intense pulse light= Lumenis M22
400-1200nm, Q-Switched Nd:YAG Laser,
Multi-Spot Nd:YAG Laser