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Nicholas Pondelis, Milton M Hom, Leslie E O'Dell, Arsia Jamali, Pedram Hamrah; Detection and Assessment of Treatment Efficacy of Demodex Blepharitis by In Vivo Confocal Microscopy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):136.
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© ARVO (1962-2015); The Authors (2016-present)
Eyelid infestation by Demodex folliculorum can lead to blepharitis and result in ocular discomfort. Classic detection is performed by lash epilation and assessment under a light microscope, although mites are not typically quantified. Laser in vivo confocal microscopy (IVCM) has been shown to be an effective tool for the detection of Demodex mites. This retrospective chart review aimed to explore the effect of D. folliculorum treatment on mite and egg density.
In this retrospective chart review, 11 patients (sex ratio: 6:5; F:M; average age: 60.7±3.93 years) were selected from a population previously treated for D. folliculorum that received an IVCM exam, and then returned for follow-up IVCM testing. IVCM examinations consisted of serial imaging of each patient’s eyelid margin, around the lash follicle. Images were analyzed in a masked fashion for the presence of Demodex mites and eggs around the base of the lash. Quantified images were selected from IVCM exams performed before and after the start of treatment with topical 4-Terpineol (T4O) wipes or combination of T4O wipes and oral ivermectin, with an average of 177.4 days between imaging sessions.
At baseline the mean mite density per follicle was 4.42±0.44, with an egg per follicle density of 1.93±0.22. Patients were treated with topical T4O wipes or combination of topical T4O wipes and ivermectin. After treatment, mite density was 2.42±0.22 mites per follicle, and egg density was 3.12±0.28 eggs per follicle. There was a significant decrease in the density of D. folliculorum mites after treatment, compared to baseline (p = 0.01). Surprisingly, there was also a significant increase in the eggs of D. folliculorum after treatment when compared to baseline (p = 0.011).
Demodex folliculorum mites and eggs were detected by laser IVCM in patients treated for D. folliculorum with topical T4O wipes or combination of topical T4O wipes and ivermectin. Treatment resulted in a significant reduction in the mite population, while it also led to an increase in the prevalance of detectable Demodex eggs. Typically, as lash collarettes and detectable mites become less frequent, treatment is tapered. IVCM provides a means by which to actively monitor treatment of Demodex blepharitis by directly observing the mite in all phases of its lifecycle during treatment, and can help guide clinical decisions regarding treatment length.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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