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A. Kheirkhah, V. Casas, G. Blanco, V.-K. Raju, S. C. G. Tseng; Corneal Manifestations of Ocular Demodex Infestation. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3648.
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To report the corneal manifestations in eyes with Demodex infestation of the eyelids.
This retrospective review included 6 patients with Demodex blepharitis that also exhibited corneal surface abnormalities, which led to suspicion of limbal stem cell deficiency in three cases. All patients received weekly lid scrub with 50% tea tree oil and daily lid scrub with tea tree shampoo for a minimum of 6 weeks. Improvement of symptoms and corneal and conjunctival signs was evaluated.
All 6 patients exhibited ocular irritation and conjunctival inflammation, while meibomian gland dysfunction (n=5), rosacea (n=4), and decreased vision (n=3) were also noted despite prior treatments with oral tetracycline, topical steroids with antibiotics, and lid scrub by baby shampoo. They were proven to have Demodex folliculorum (n=6) and Demodex brevis (n=3) by microscopic examination of epilated lashes. Their corneal manifestation included superficial corneal vascularization (6 eyes of 5 cases), marginal corneal infiltration (2 eyes of 2 cases), phlyctenule-like lesion (1 eye of 1 case), superficial corneal opacity (2 eyes of 2 cases), and nodular corneal scar (2 eyes of 2 cases). After treatment with tea tree oil, the Demodex count was reduced from 6.8 + 2.8 to 1 + 0.9 (P= 0.001). All patients showed dramatic resolution of ocular irritation, conjunctival inflammation, and all inflammatory, but not scarred, corneal signs; three patients showed improved vision.
A variety of corneal pathologies together with conjunctival inflammation, commonly noted in rosacea, can be found in patients with Demodex infestation of the eyelids. When conventional treatments for rosacea fail, one might consider lid scrub with tea tree oil to eradicate mites as a new treatment.
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