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Lingyi Liang, Yile Chen, Chu Li, Jiaqi Chen; Demodex infestation as a potential cause of keratitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2829.
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To report Demodex infestation in keratitis.
This retrospective review included 15 patients with refractory keratitis. Demodex mites were detected by lash sampling and microscopic examination. Meibomian gland and tear lipid layer image changes were evaluated by Oculus Keratography-5. Patients were treated with 50% tea tree oil (TTO) eyelid scrubs or 5% TTO ointment eyelid massages for 8 weeks. Improvement of symptoms and corneal and conjunctival signs, as well as lipid tear image was evaluated.
The patients included 8 males and 4 females with an average age of 17.8±12.1 years (range, 6-53 years). Demodex mites were detected in all cases including Demodex folliculorum in 14 cases and Demodex brevis in 13 cases. Bacterial, fungal and virus culture were negative in all cases. All patients manifested persistent ocular irritation, lid margin and conjunctival inflammation, and keratitis despite prior antibacterial, antiviral, and anti-inflammatory treatment. The corneal changes included peripheral infiltration in 8 cases, peripheral ulceration in 4 cases, central infiltration in 2 cases, and diffusive superficial punctuate keratopathy in 1 case. Superficial corneal vascularization was also noted in 13 cases. Meibomian gland morphologic changes such as gland drop out and orifice obstruction as well as disturbed lipid image was also revealed in all cases. After TTO treatment, all patients showed dramatic resolution of ocular inflammation while Demodex counts dropped from 4.3±2.5 to 0.4±0.6 (P< .001). All corneal signs resolved within 2 weeks except for residual stromal scar in 4 eyes. Improved lipid tear images were also revealed after treatment in all cases. During a follow-up period of 11±4.7 months, 1 patient showed recurrent inflammation, which was successfully managed by a second round of TTO treatment.
Ocular Demodex infestation may also involve the cornea. Demodicosis should be considered as a potential cause of refractory keratitis. Eyelid scrubs or massage with TTO could be an effective treatment regimen in these cases.
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