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Association Between Ocular and Facial Demodicosis
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To determine the association between ocular and facial demodicosis, and the effect of facial treatment on ocular demodicosis.
DESIGN
Prospective clinical cohort study.
METHODS
Ocular demodicosis outpatients from a tertiary medical center were enrolled from April to December 2020. The diagnosis was based on epilation of four eyelashes from each upper eyelid. High ocular Demodex load (ODL) was defined as ≥8 mites per eye. Facial infestation was assessed by direct microscopic examination, with facial Demodex overgrowth (FDO) defined as a density >5 mites/cm2. All patients were prescribed three months of ocular treatment, and FDO patients received dermatologic treatment.
RESULTS
Eighty-nine patients were enrolled. Among those that completed the treatment course, 39 presented high ODL. Lower cylindrical sleeve counts were found in low ODL patients (low ODL vs. high ODL: 8 vs. 14, P = 0.009). FDO was less prevalent in this group (49% vs. 77%, P = 0.012). The Ocular Surface Disease Index score decreased in patients without FDO (20.0 ± 17.1 to 14.0 ± 16.6, P = 0.027) after three months of topical tea tree oil treatment. Topical ivermectin treatment on the facial skin provided a higher ocular Demodex eradication rate in FDO patients (76% vs. 16%, P < 0.001).
CONCLUSION
Concurrence of ocular and facial demodicosis is common, especially in cases of severe ocular demodicosis. While ocular treatment alone is effective for patients with ocular demodicosis only, co-treatment with topical ivermectin on the facial skin enhances ocular Demodex eradication in patients with comorbid facial Demodex overgrowth.
Additional Info
Comorbidity of Ocular and Facial Demodicosis
Am J Ophthalmol 2024 Jan 01;257(xx)201-211, WL Huang, CM Huang, CY Chu, FR HuFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
A Demodex infestation on eyelids or facial skin is not uncommon, especially in older adults. This manuscript in the ophthalmology literature evaluated the prevalence of facial demodicosis in the setting of ocular demodicosis. The authors further evaluated whether concurrent treatment of facial demodicosis helped to eradicate ocular demodicosis.
In the cohort of patients affected by ocular demodicosis, 62% were found to have concurrent Demodex overgrowth on the facial skin; however, only 26% presented with clinically significant facial demodicosis. Therefore, many of the patients with facial demodicosis would have been underdiagnosed and left untreated if only ophthalmologic evaluations had been performed. Hence, the concurrence of facial Demodex overgrowth should not be overlooked in patients with ocular demodicosis.
One important sign of ocular demodicosis is cylindrical sleeves (also known as cylindrical dandruff or collarettes) at the base of the eyelashes. These patients often have concomitant pruritus on their eyelids. In these patients, the dermatologist should evaluate the facial skin closely for signs of demodicosis. Even if no signs of demodicosis exist, further microscopic evaluation may be warranted to see whether there are excess of Demodex mites on the face. As demonstrated by this article, treatment of the facial skin, whether or not it is clinically obviously overgrown with Demodex mites, may help to eradicate ocular demodicosis. In order to be an astute dermatologist and exceptional clinician, dermatologists must not forget to look at subtle findings, even those on the eyelashes. Evidence of cylindrical sleeves may warrant further evaluation of the facial skin to help reduce Demodex mites and thus improve our patients' symptoms such as eyelid pruritus.