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J. Li, L. Liang, S. Safran, Y. Gao, H. Sheha, S. Tseng; Ocular Demodicosis as a Potential Cause of Pediatric Blepharoconjunctivitis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2606.
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To report Demodex infestation in pediatric patients with refractory blepharoconjunctivitis.
This retrospective review included 12 pediatric patients, aged 7.5 ± 2.5 years (range, 2.5 to 11), with refractory blepharocounjuctivitis. Demodex mites were found in all but one case, which also had cylindrical dandruff in lashes. Six patients received weekly lid scrubs with 50% tea tree oil (TTO) for 4 to 6 weeks; the others received lid massage with 5% TTO ointment for 4 weeks. Symptoms and ocular surface inflammation were evaluated.
Before treatment, all patients exhibited bilateral ocular irritation and inflammation in lid margin and conjunctiva, while 10 had bilateral meibomian gland dysfunction, 4 had multiple recurrent chalazia. Additionally, there were corneal infiltrates (3 eyes), superficial punctuate keratopathy (2 eyes), phlyctenular keratitis (2 eyes), and corneal ulcer (1 eye). After 1 week of TTO treatment, all patients showed dramatic resolution of ocular irritation and inflammation while Demodex counts dropped. All corneal signs resolved within 2 weeks except residual anterior stromal scar in one eye. During a follow-up period of 7.9 ± 4.9 months one patient showed recurrent inflammation which was successfully managed by the same regimen.
Demodicosis can be detected in healthy children during their first decade of life. It should be considered a potential cause of pediatric refractory blepharoconjunctivitis when associated with meibomian gland dysfunction, recurrent chalazia or corneal changes. Such patients respond well to lid scrub with TTO-based treatment. Further investigation into the pathogenicity of ocular Demodicosis is warranted.
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