Article

The effect of Blephadex™ Eyelid Wipes on Demodex mites, ocular microbiota, bacterial lipase and comfort: a pilot study

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Abstract

Purpose: To investigate the effect of Blephadex™ Eyelid Wipes on Demodex mites, ocular microbiota, bacterial lipase, tear film characteristics and ocular comfort after one month of daily use. Methods: Twenty subjects were randomly assigned to use the Blephadex™ Eyelid Wipes on either eye once daily for 30 days whilst the contralateral eye was left untreated in this observer-masked, within-subject study. Demodex count, eyelid bacterial colony count, Tearscope Plus non-invasive tear break up time (NITBUT), Lipiview® tear film lipid layer thickness and phenol red thread test tear volume were measured at baseline and 30 days. Bacterial lipase was quantified from single bacterial colonies using a glycerol monolaurate assay. Ocular comfort was assessed at both visits using the Ocular Surface Disease Index (OSDI) questionnaire and visual analogue scales (VAS) to capture monocular symptoms of itching, dryness and overall discomfort. Results: Six males and 14 females, median age 63.5 (range 48-76) completed the study. A statistically significant reduction in Demodex count was observed in treated eyes only (median ± IQR: treated eyes 2 ± 3 vs. 0 ± 2, ANOVA p = 0.04). Bacterial colony count, lipase production, NITBUT, lipid layer thickness and tear volume remained unchanged (p > 0.05). Overall comfort improved over time in treated eyes only (15 ± 32 vs. 10 ± 16, p = 0.05). Dryness symptoms significantly reduced in both treated and untreated eyes (23 ± 42 vs. 12 ± 21 and 23 ± 41 vs. 10 ± 15, p = 0.02). The OSDI and ocular itch scores remained unchanged (p > 0.05). Conclusion: In this pilot study, no changes were observed in ocular microbiota, tear film characteristics or bacterial lipase in eyes treated with Blephadex™ Eyelid Wipes after one month of daily use in this normal healthy population. Although a statistically significant reduction in Demodex count was observed in treated eyes, overall numbers of Demodex were low. A parallel group, placebo-controlled, randomised clinical trial in a population with active blepharitis is warranted to further elucidate these preliminary findings.

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... Nine studies were published in the field of infectious disease addressing hand disinfection [n = 3; (Gnatta et al., 2013;Gnatta et al., 2021;Youn et al., 2021)], MRSA decolonization [n = 4; (Caelli et al., 2000;Dryden et al., 2004;Blackwood et al., 2013;Lee et al., 2014)] or prevention of MRSA colonization [n = 1; (Blackwood et al., 2013)], molluscum contagiosum [n = 1; (Markum and Baillie, 2012)], or oral Candida infection [n = 1; (Maghu et al., 2016)]. Six studies were published in the field of ophthalmology addressing Demodex infestation [n = 4; (Koo et al., 2012;Karakurt and Zeytun, 2018;Wong et al., 2019;Craig et al., 2022)], dry eye post cataract surgery [n = 1; (Mohammadpour et al., 2020)], or meibomian gland dysfunction [n = 1; (Zarei-Ghanavati et al., 2021)]. Three studies were published in the field of podiatry addressing onychomycosis [n = 1; (Buck et al., 1994)], or tinea pedis [n = 2; (Tong et al., 1992;Satchell et al., 2002b)]. ...
... Six trials were published in the field of ophthalmology from 2012 to 2021, and were conducted in Australia (Wong et al., 2019), Canada (Craig et al., 2022), Iran (Mohammadpour et al., 2020;Zarei-Ghanavati et al., 2021), Korea (Koo et al., 2012), or Turkey (Karakurt and Zeytun, 2018), within the hospital or outpatient clinic setting. ...
... Three studies tested tea tree oil-based eyelid wipes, washes or scrubs for control of Demodex mites in subjects with diagnosed demodectic blepharitis (Karakurt and Zeytun, 2018), ocular surface discomfort (Koo et al., 2012), or in generally healthy adults (Wong et al., 2019). Karakurt and Zeytun (2018), compared twice daily eyelid washes with Blefaroshampoo ® (with 7.5% tea tree oil) with Blepharitis Shampoo (without tea tree oil) in 135 adult subjects (Karakurt and Zeytun, 2018). ...
Article
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Introduction: Leaves of the Australian tea tree plant Melaleuca alternifolia were used traditionally by First Nations Australians for treating wounds, burns, and insect bites. Tea tree oil, the essential oil steam-distilled from M. alternifolia, is well-known for its medicinal properties, the evidence for most applications however is limited. This review aimed to critically appraise evidence from clinical trials examining the therapeutic efficacy and safety of tea tree oil on outcomes. Methods: Randomized controlled trials with participants of any age, gender, or health status, comparing tea tree oil to any control were included, without limit on publication date. Electronic databases were searched on 12 August 2022 with additional records sourced from article reference sections, reviews, and industry white papers. Risk of bias was assessed by two authors independently using the Cochrane risk-of-bias 1.0 tool. Results were summarized and synthesized thematically. Results: Forty-six articles were eligible from the following medical fields (Dentistry n = 18, Dermatology n = 9, Infectious disease n = 9, Ophthalmology n = 6, Podiatry n = 3; and Other n = 1). Results indicate that oral mouthwashes with 0.2%–0.5% tea tree oil may limit accumulation of dental plaque. Gels containing 5% tea tree oil applied directly to the periodontium may aid treatment of periodontitis as an adjunctive therapy to scaling and root planing. More evidence is needed to confirm the benefits of tea tree oil for reducing acne lesions and severity. Local anti-inflammatory effects on skin, if any, also require further elucidation. Topical tea tree oil regimens show similar efficacy to standard treatments for decolonizing the body from methicillin-resistant Staphylococcus aureus, although intra-nasal use of tea tree oil may cause irritation to mucous membranes. Tea tree oil with added iodine may provide an effective treatment for molluscum contagiosum lesions in young children. More evidence on efficacy of tea tree oil-based eyelid wipes for Demodex mite control are needed. Side effects were reported in 60% of included studies and were minor, except where tea tree oil was applied topically in concentrations ≥ 25%. Discussion: Overall, the quality of research was poor to modest and higher quality trials with larger samples and better reporting are required to substantiate potential therapeutic applications of tea tree oil. Systematic Review Registration: PROSPERO, identifier [CRD42021285168].
... The reviewed studies were conducted in Europe (n = 23) , Asia (n = 21) , North America (n = 15) [95][96][97][98][99][100][101][102][103][104][105][106][107][108][109], Australia and New Zealand (n = 11) [110][111][112][113][114][115][116][117][118][119][120], and Africa (n = 2) [31,121]. Except the four studies published in Mandarin [87,88,90,94], all studies were published in English. ...
... Except the four studies published in Mandarin [87,88,90,94], all studies were published in English. Most (n = 41) of the included studies were clinical studies involving 2456 participants, with RCT (n = 17) [56,62,63,72,74,77,85,86,88,92,93,107,108,110,111,120,121] or non-RCT (n = 24) type study designs [52,58,59,61,69,73,75,76,78,79,82,87,[89][90][91]94,98,99,101,102,106,109,113,117]. While 25 of them were solely laboratory-based studies with in vitro (n = 24) [31,[53][54][55]57,60,[64][65][66][67][68]70,71,80,83,84,95,100,104,112,[114][115][116]119] and in vivo [96] designs. ...
... Acaricidal effect of TTO and its components against mites. Fifty-five studies targeted mites, which include Demodex mites (n = 44) [52,56,58,59,[61][62][63][64][69][70][71][72][73][74][75][76][77][78][79]81,82,85,[87][88][89][90][91][92][93][94][97][98][99][100][101][102][107][108][109]112,114,117,120,121], scabies mites (n = 5) [57,86,113,118,119], and house dust mites (n = 6) (Tables 1-5) [60,65,68,80,83,116]. Of these, 14 [57,60,64,65,68,70,71,80,83,100,112,114,116,119] were in vitro studies, while three studies [81,97,118] followed a mixed in vitro/clinical approach, and 38 were clinical (inter-ventional) studies (15 RCTs [56,62,63,72,74,77,85,86,88,92,93,107,108,120,121] and 23 non-RCTs [52,58,59,61,69,73,75,76,78,79,82,87,[89][90][91]94,98,99,101,102,109,113,117]). ...
Article
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Ectoparasites are pathogens that can infect the skin and cause immense pain, discomfort, and disease. They are typically managed with insecticides. However, the fast-emerging antimicrobial resistance and the slow rate of development of new bio-actives combined with environmental and health concerns over the continued use of neurotoxic insecticides warrant newer and alternative methods of control. Tea tree oil (TTO), as an alternative agent, has shown remarkable promise against ectoparasites in recent studies. To our knowledge, this is the first systematic review to assess preclinical and clinical studies exploring the antiparasitic activity of TTO and its components against clinically significant ectoparasites, such as Demodex mites, scabies mites, house dust mites, lice, fleas, chiggers, and bed bugs. We systematically searched databases, including PubMed, MEDLINE (EBSCOhost), Embase (Scopus), CENTRAL, Cochrane Library, CINAHL, ScienceDirect, Web of Science, SciELO, and LILACS in any language from inception to April 04, 2022. Studies exploring the therapeutic activity of TTO and its components against the ectoparasites were eligible. We used the ToxRTool (Toxicological data reliability assessment) tool, the Joanna Briggs Institute (JBI) critical appraisal tools, and the Jadad scale to assess the methodological qualities of preclinical (in vitro and in vivo) studies, non-randomised controlled trials (including cohort, case series, and case studies), and randomised controlled trials, respectively. Of 497 identified records, 71 studies were included in this systematic review, and most (66%) had high methodological quality. The findings of this review revealed the promising efficacy of TTO and its components against ectoparasites of medical importance. Most importantly, the compelling in vitro activity of TTO against ectoparasites noted in this review seems to have translated well into the clinical environment. The promising outcomes observed in clinical studies provide enough evidence to justify the use of TTO in the pharmacotherapy of ectoparasitic infections.
... The included studies evaluated 1195 participants and 1574 eyes that were positive for Demodex infestation and differed from each other with respect to the length of follow-up (from 28 to 90 days) and the type of evaluated interventions. In total, 4 studies compared a therapeutic intervention versus placebo [28][29][30][31], 12 studies assessed an intervention versus other interventions [17,23,25,26,[32][33][34][35][36][37][38][39], and 2 studies compared an intervention versus the absence of treatment [40,41]. Only one study was specifically designed to evaluate adverse reactions [38]. ...
... TTO-derived treatments were evaluated in 11 studies [17,25,28,29,31,33,[35][36][37][38]40], 9 studies evaluated non-TTO-derived treatments [23,25,26,30,32,34,38,39,41], only 1 study evaluated systemic medications [23], and 3 studies evaluated non-pharmacological interventions [25,26,39]. ...
... Thirteen studies were included in this analysis [17,23,25,26,28,30,[33][34][35][36][39][40][41]. An overall RR of 1.84 (95 % CI 1.27-2.66) ...
Article
Purpose A systematic review and meta-analysis was performed to evaluate the effectiveness of interventions in the treatment ofDemodex blepharitis in adult patients. Methods A systematic review and meta-analysis of studies reporting the efficacy of treatments forDemodex blepharitis in the main databases (PubMed / Scopus / Cochrane / EMBASE / Science Direct / WOS / Scielo / Google Scholar / metaRegister of Controlled Trials / ClinicalTrials.gov/ WHO ICTRP) until November 24, 2020 was performed according to the PRISMA statement for meta-analysis. Results Overall, 18 studies were included for 29 different interventions in 1195 participants with 1574 eyes that were positive for Demodex Spp. Demodex counts, total eradication, clinical improvement, Ocular Surface Disease Index, Tear Break-Up Time, cylindrical dandruff, Schirmer test, osmolarity and adverse reactions were analysed, and stratified sub-analyses conducted. The overall effects for Demodex count (mean difference), total eradication (risk ratio) and adverse reactions (risk difference) were -2.07 (95 % CI -3.99 to -0.15) p = 0.03, 1.84 (95 % CI 1.27–2.66) p = 0.001 and 0.24 (95 % CI 0.08 to 0.41) p = 0.005, respectively. The most frequent interventions evaluated in the included studies were tea tree oil (TTO) and its derivatives, such as terpinen 4-ol. Conclusion Multiple therapeutic choices were evaluated in this meta-analysis. Pharmacological interventions were superior to non-pharmacological (mechanical, thermal and pulsed light) interventions. It was not possible to establish significant differences between TTO and non-TTO-derived treatments. Adverse reactions were more frequent in TTO-derived treatments, however all were mild. It is necessary to execute studies with longer follow-up times to determine whether re-infestation occurs after the administration of different treatments.
... Management of Demodex blepharitis to date has no FDAapproved pharmaceutical option and typically involved lid hygiene products such as TTO and okra-based products. 5,12,22,29,[42][43][44][45][46][47] The available evidence demonstrates questionable levels of efficacy. 3,4,12,27,28,30,44,48 At-home use of lid scrubs and wipes containing 3% to 10% TTO or one of its derivatives, T4O, has been recommended by some groups, 5,42 but there have been very few studies published in which these agents are compared with a control group. ...
... 3,4,12,27,28,30,44,48 At-home use of lid scrubs and wipes containing 3% to 10% TTO or one of its derivatives, T4O, has been recommended by some groups, 5,42 but there have been very few studies published in which these agents are compared with a control group. 42,45,47 Mite eradication rates with these products have been reported to be low, and side effects such as ocular irritation, burning sensation, contact dermatitis, and allergy have been reported. 12,29,30,49,50 Before this phase 2b/3 study, the study drug, topical lotilaner ophthalmic solution, 0.25%, has been extensively evaluated in several phase 2 clinical trials. ...
Article
Full-text available
Purpose: The purpose of this study was to evaluate the safety and efficacy of lotilaner ophthalmic solution, 0.25%, compared with vehicle for the treatment of Demodex blepharitis. Methods: In this prospective, randomized, controlled, double-masked, phase 2b/3 clinical trial, 421 patients with Demodex blepharitis were randomly assigned in a 1:1 ratio to receive either lotilaner ophthalmic solution, 0.25% (study group), or vehicle without lotilaner (control group) bilaterally, twice daily for 43 days. Patients were evaluated at days 8, 15, 22, and 43. Outcome measures were complete collarette cure (collarette grade 0), clinically meaningful collarette cure (grade 0 or 1), mite eradication (0 mites/lash), erythema cure (grade 0), composite cure (grade 0 for collarettes/erythema), and drop comfort. Adverse events were also evaluated. Results: At day 43, the study group achieved a statistically significantly higher proportion of patients with clinically meaningful collarette cure (81.3% vs. 23.0%; P < 0.0001), complete collarette cure (44.0% vs. 7.4%; P < 0.0001), mite eradication (67.9% vs. 17.6%; P < 0.0001), erythema cure (19.1% vs. 6.9%; P = 0.0001), and composite cure (13.9% vs. 1.0%; P < 0.0001) than the control group. Nearly 92.0% of patients rated the study drop as neutral to very comfortable. All ocular adverse events in the study group were mild, with the most common being instillation site pain. Conclusions: Twice-daily treatment with a novel lotilaner ophthalmic solution, 0.25% for 43 days, is safe and effective for the treatment of Demodex blepharitis compared with the vehicle control.
... However, the potential ocular toxicity of tea tree oil has been identified [20], and recognised to cause significant irritation, particularly at higher concentrations or with prolonged periods of exposure [15,16,19]. Commercial anti-demodectic eyelid cleansers containing lower concentrations of tea tree oil or the active ingredient terpinen-4-ol have therefore been developed, however, their clinical safety and tolerability warrants further investigation [21][22][23][24]. Widespread anecdotal reports from patients, of irritation on application, are supported by evidence in the literature that a number of commercial anti-demodectic eyelid cleansing formulations can induce significant ocular discomfort [23]. ...
... It is acknowledged that the long-term clinical efficacy of the anti-demodectic efficacy of the commercial eyelid cleansers could not be assessed in the current study. Although, the in vivo antidemodectic activity of a number of commercial eyelid cleansers and the one-month clinical benefits of BDdx has previously been reported [21,22,24], further research is required to characterise and compare the long-term clinical efficacy and safety of a wider range of commercial anti-demodectic eyelid cleansers in treating blepharitis. ...
Article
Purpose To evaluate the short-term tolerability of five commercially available anti-demodectic eyelid cleansers; OCuSOFT Oust Demodex (OD), I-MED I-Lid’n Lash Plus (ILL+), Labtician BlephaDex (BD), Chrissanthe Eye Cleanse (EC), and Théa Blephademodex (BDdx). Methods Thirty healthy non-contact lens wearers (18 female; mean ± SD age, 33 ± 12 years) were enrolled in a prospective randomised crossover study. On separate visits, spaced at least 48 h apart, participants were randomised to receive topical application of one of five eyelid cleansers or saline. Participants rated subjective ocular discomfort during the 10-minute post-application period. Visual acuity, non-invasive tear film stability, conjunctival hyperaemia, and ocular surface staining were assessed at baseline and 10 min. Results No inter-group differences in ocular parameters were noted at baseline (all p > 0.05). Ocular discomfort scores significantly exceeded baseline scores for 60 s following BD application, 120 s with OD, 135 s with BDdx, 150 s with ILL+, and 195 s with EC (all p < 0.05). Deterioration in non-invasive tear film stability, limbal conjunctival hyperaemia, as well as corneal, conjunctival, and lid margin staining was detected following EC application (all p < 0.05), and increased bulbar conjunctival hyperaemia was observed following both EC and ILL+ treatment (both p < 0.05). Conclusions Study outcomes highlight varying tolerability profiles with different anti-demodectic lid cleanser preparations, and the potential to induce tear film instability, conjunctival hyperaemia and ocular surface staining on application. Awareness of possible adverse effects arising from topical application of commercial anti-demodectic lid cleanser formulations may help clinicians set realistic patient expectations and encourage better compliance in their use of lid hygiene therapies.
... Products already marketed and intended for the treatment of blepharitis and Demodex have already been tested. Wong et al. (2019) analysed the effect of Blephadex TM (Lunovus, LLC, Morris, Alabama, USA) on mites and observed a significant reduction in the number of Demodex on treated eyes. According to the manufacturer's data, Blephadex TM composition includes TTO and coconut oil, with anti-microbial and anti-inflammatory properties (Verallo-Rowell et al. 2008;Intahphuak et al. 2010). ...
... According to the manufacturer's data, Blephadex TM composition includes TTO and coconut oil, with anti-microbial and anti-inflammatory properties (Verallo-Rowell et al. 2008;Intahphuak et al. 2010). Coconut oil inhibits the production of bacterial lipase as lipases are necessary for Demodex to digest sebum when feeding (Jimenez-Acosta et al. 1989;Liu et al. 2010;Wong et al. 2019). ...
Article
The mites Demodex folliculorum (Simon) and Demodex brevis Akbulatova are part of the regular human skin fauna, found in the pilosebaceous unit, and their infestations might cause the disease known as demodicosis. Inflammatory response is triggered by this interaction in patients, causing the appearance of several facial dermatoses. In the present revision, mites will be characterized and their association with dermatological diseases shall be discussed, as well as diagnostic methods, immune response to their infestations, and the major treatments used for Demodex-related cases. Demodex infestations both in hair follicles (D. folliculorum) and in sebaceous glands (D. brevis) might lead to the aggravation of dermato-facial pathologies, and trigger a local inflammatory reaction in many cases, associated with mite density and their potential as vectors of pathogenic microorganisms. The treatments for these Demodex-associated pathologies have proven to be effective, particularly in decreasing density, and consequently, in mitigating symptoms and the overall patient clinical condition.
... TTO is obtained from the leaves of the Australian native tree Melaleuca alternifolia and contains known ingredients, of which the most common is terpinene-4-ol (T4O), which has a strong demodectic affinity [56]. An increasing number of eyelid hygiene products are available to combat infection with demodex [4,58], containing either TTO or T4O in various concentrations [6,38]. Linalool, alcohol, which is the main component of rosewood (Aniba rosaeodora) and camphor tree (Cinamomon camphora) oils., they have also been found to have strong antimicrobial properties, including leishmanicidal effects. ...
Article
Relevance. Demodex is the most common parasite found on humans, and yet little is known about its pathogenicity in relation to the ocular surface. The growing interest in demodex over the past 20 years has expanded our understanding of this tick and its pathogenetic role. Despite the growing interest in demodex in the literature, numerous obstacles remain for future research, so the section of this review is devoted to identifying and proposing for future consideration. The lack of uniformity in terms of terminology, diagnostic methods and approach to the treatment of demodex remains an obstacle to future comparisons of studies. This review summarizes current knowledge about demodex and hopes to offer some recommendations for future directions in the study of demodex in humans. Search strategy. The study examined full-text publications in English and Russian, which are devoted features of the pathology development of human demodicosis. In the process of searching for literature, the following search engines were used: Pubmed, Web of science, Cyberleninka, Google Scholar by keywords. The time period was designated 2007-2022. 299 publications were identified on this topic. Of these, 61 publications corresponded to the purpose of our study. Inclusion criteria: Publications of the level of evidence A, B: meta-analyses, systematic reviews, cohort and cross-sectional studies. Exclusion criteria: summary reports, newspaper articles and personal messages. Results and conclusions. Papulopustular rosacea and demodecosis are common facial skin diseases that can be difficult to diagnose clinically. In addition to well-known clinical signs such as vascular signs and papules, in our study of patients with known papulopustular rosacea or demodecosis, we have shown that other clinical signs are also often present (inconspicuous follicular scales on the face, dandruff, folliculitis on the scalp, itching of the face or scalp). Therefore, the presence of these signs and symptoms should encourage dermatologists to conduct further diagnostic tests (for example, the recently described test based on the high density of demodex mites observed in these conditions) to ensure an accurate diagnosis. Актуальность. Демодекс является наиболее распространенным паразитом, встречающимся у людей, и все же мало что известно о его патогенности по отношению к глазной поверхности. Растущий интерес к демодексу за последние 20 лет расширил наше понимание этого клеща и его патогенетической роли. Несмотря на растущий интерес к демодексу в литературе, для будущих исследований остаются многочисленные препятствия, поэтому раздел этого обзора посвящен выявлению и предложению для дальнейшего рассмотрения. Отсутствие единообразия с точки зрения терминологии, методов диагностики и подхода к лечению демодекса остается препятствием для будущих сравнений исследований. Этот обзор обобщает современные знания о демодексе и надеется предложить некоторые рекомендации для будущих направлений в изучении демодекса у людей. Стратегия поиска. В исследовании изучены полнотекстовые публикации на английском и русском языках, которые посвящены особенностям развития патогенеза демодекоза человека. В процессе поиска литературы использованы следующие поисковые системы: Pubmed, Web of science, Cyberleninka, Google Scholar по ключевым словам. Временной период был обозначен 2007-2022 годами. По данной теме выявлено 299 публикаций. Из них цели нашего исследования соответствовало 61 публикаций. Критерии включения: Публикации уровня доказательности А, В: мета-анализы, систематические обзоры, когортные и поперечные исследования. Критерии исключения:краткие отчеты, газетные статьи и личные сообщения. Результаты и выводы. Папулопустулезная розацеа и демодекоз являются распространенными заболеваниями кожи лица, которые трудно диагностировать клинически. В дополнение к хорошо известным клиническим признакам, таким как сосудистые признаки и папулы, в нашем исследовании пациентов с известной папулопустулезной розацеа или демодекозом мы показали, что часто присутствуют и другие клинические признаки (незаметные фолликулярные чешуйки на лице, перхоть, фолликулит на коже головы, зуд лица или кожи головы). Следовательно, наличие этих признаков и симптомов должно побудить дерматологов провести дальнейшие диагностические тесты (например, недавно описанный тест, основанный на высокой плотности клещей демодекса, наблюдаемых в этих условиях), чтобы обеспечить точный диагноз. Түйін. Демодекс - бұл адамдарда кездесетін ең көп таралған паразит, бірақ оның көз бетіне қатысты патогенділігі туралы аз мәлімет бар. Соңғы 20 жылдағы демодекске деген қызығушылықтың артуы осы кене және оның патогенетикалық рөлі туралы түсінігімізді кеңейтті. Әдебиеттегі демодекске деген қызығушылықтың артуына қарамастан, болашақ зерттеулерге көптеген кедергілер бар, сондықтан осы шолудың бөлімі анықтауға және әрі қарай қарастыруға арналған. Терминология, диагностикалық әдістер және демодексті емдеу тәсілдері тұрғысынан біркелкіліктің болмауы болашақ зерттеулерді салыстыруға кедергі болып қала береді. Бұл шолу демодекс туралы қазіргі заманғы білімді жинақтайды және адамдарда демодексті зерттеудің болашақ бағыттары үшін кейбір ұсыныстар ұсынады деп үміттенеді. Іздеу стратегиясы. Зерттеу адам демодекозының патогенезінің дамуына арналған ағылшын және орыс тілдеріндегі толық мәтінді басылымдарды зерттеді. Әдебиеттерді іздеу барысында келесі іздеу жүйелері қолданылды: Pubmed, Web of science, Cyberleninka, Google Scholar кілт сөздер. Уақыт кезеңі 2007-2022 жылдармен белгіленді. Осы тақырып бойынша 299 жарияланым анықталды. Олардың ішінде біздің зерттеуіміздің мақсаты 61 басылымға сәйкес келді. Қосу критерийлері: А, В дәлелділік деңгейінің жарияланымдары: мета-талдаулар, жүйелі шолулар, когорттық және көлденең зерттеулер. Шығару критерийлері: қысқаша есептер, газет мақалалары және жеке хабарламалар. Нәтижелер мен қорытындылар. Папулопустулярлы розацея және демодекоз-бұл клиникалық диагноз қою қиын бет терісінің жиі кездесетін аурулары. Тамырлы белгілер мен папула сияқты белгілі клиникалық белгілерден басқа, белгілі папулопустулярлы розацея немесе демодекозы бар пациенттерді зерттеуде біз басқа клиникалық белгілердің жиі кездесетінін көрсеттік (бетіндегі көрінбейтін фолликулалық таразылар, қайызғақ, бас терісіндегі фолликулит, бет немесе бас терісінің қышуы). Сондықтан, осы белгілердің болуы дәл диагнозды қамтамасыз ету үшін дерматологтарды қосымша диагностикалық сынақтарға итермелеуі керек (мысалы, осы жағдайларда байқалған демодекс кенелерінің жоғары тығыздығына негізделген жақында сипатталған тест).
... Lid hygiene reduces not only microbiota on the eyelid but also demodex mites on the eyelid. 8,22,23 Demodex mites are commonly found in the eyelashes of elderly and dry eye patients. Previous reports revealed they cause negative changes on the eyelid and are responsible for anterior and posterior blepharitis. ...
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Purpose To evaluate the effect of eyelid hygiene after cataract surgery on eyelid and ocular surface findings, subjective symptoms and visual function, including functional visual acuity (FVA) and higher order aberration, in a randomized controlled study. Methods Fifty patients who underwent cataract surgery at a single institution were involved. Twenty-five patients were instructed to wipe their eyelids twice a day from one to four weeks postoperatively, whereas the other 25 patients did not perform any eyelid hygiene. Optical measurement, FVA, meibomian glands, the grade of meibum, lid margin findings, fluorescein corneal staining findings, dry eye-related subjective symptoms and surgical satisfaction were assessed both preoperatively and one month postoperatively. Results In the eyelid hygiene group, the visual maintenance ratio of FVA improved significantly (p = 0.048) and the higher order aberration of the 4th + 6th order deteriorated less (p = 0.027) compared with the control group. Multiple regression analyses showed that the change in visual maintenance ratio was associated with surgical satisfaction (p = 0.003), change in corneal staining score (p = 0.007), history of eye diseases (p = 0.029) and eyelid hygiene (p = 0.048). Conclusions Eyelid hygiene after cataract surgery may be effective for visual function measured with an FVA test.
... These wipes greatly reduce the microbiota on the eyelids are more comfortable and can be easily used by patients. [49,50] ...
Article
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Nowadays, people give more importance and pay closer attention to the condition of their eyelids and lid margins. This increased recognition of eyelid hygiene is due to the growing awareness that improper eyelid cleaning might lead to various ocular surface diseases such as blepharitis and meibomian gland dysfunction. These ocular surface diseases can greatly affect people's quality of life. This article reviews the latest procedures for proper eyelid cleaning, including indications, methods, tools, detergents, and clinical applications, to maintain a healthy ocular surface and assist in the treatment of dry eye and blepharitis.
... Lid hygiene reduces not only microbiota on the eyelid, but also demodex mites on the eyelid. 8, 21 Demodex mites are commonly found in the eyelashes of elderly and dry eye patients. Previous reports revealed they cause negative changes on the eyelid and are responsible for anterior and posterior blepharitis. ...
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Purpose: To evaluate the effect of eyelid hygiene after cataract surgery on eyelid and ocular surface findings, subjective symptoms and visual function, including functional visual acuity (FVA) and higher order aberration, in a randomized controlled study. Methods: Fifty patients who underwent cataract surgery at a single institution were involved. Twenty-five patients were instructed to wipe their eyelids twice a day from one to four weeks postoperatively, whereas the other 25 patients did not perform any eyelid hygiene. Optical measurement, FVA, meibomian glands, the grade of meibum, lid margin findings, fluorescein corneal staining findings, dry eye-related subjective symptoms and surgical satisfaction were assessed both preoperatively and one month postoperatively. Results: In the eyelid hygiene group, the visual maintenance ratio of FVA improved significantly (p = 0.048) and the higher order aberration of the 4th + 6th order deteriorated less (p = 0.027) compared with the control group. Multiple regression analyses showed that the change in visual maintenance ratio was associated with surgical satisfaction (p = 0.003), change in corneal staining score (p = 0.007), history of eye diseases (p = 0.029) and eyelid hygiene (p = 0.048). Conclusions: Eyelid hygiene after cataract surgery may be effective for visual function measured with an FVA test. Trial registration: UMIN000038320. Registered on October 17, 2019.
... measured by the visual analogue scales. 33 In our study, correlation analysis showed that the Demodex load had a significant positive correlation with DCD. We have especially investigated the effects of the Demodex load on ocular surface inflammation in patients with seborrheic blepharitis without dry eye findings or meibomian gland dysfunction history to eliminate any effect of DED or MGD on the DCD and corneal sub-basal nerves. ...
Article
Purpose To compare corneal in-vivo confocal microscopy (IVCM) findings in patients with seborrheic blepharitis with healthy controls and to evaluate the correlation with the Demodex load. Methods Sixty-two Demodex positive seborrheic blepharitis patients and 24 controls were included. Four eyelashes from each eye were examined. The median value of Demodex count (5 mites/eye) was assigned as the cutoff value to create low and high Demodex infestation subgroups. Corneal nerve parameters (fiber length;CNFL, fiber density;CNFD, branch length;CNBL, branch density;CNBD) and dendritic cell density (DCD) were analyzed by IVCM for all participants. Results The mean DCD of eyes in low (37.62 ± 25.18 cells/mm²) and high (76.00 ± 44.00 cells/mm²) Demodex load groups were significantly higher than those in the control group (14.25 ± 2.68 cells/mm²) (p < .001). CNFL, CNFD, CNBL and CNBD were significantly lower in low and high Demodex groups compared to controls (p < .001). Conclusions Demodex positive seborrheic blepharitis patients showed significantly reduced density of corneal nerves and elevated DCD levels.
... Klinikai tanulmányokban a betegek hatékonyabbnak és könnyebbnek ítélték meg a szemtörlő kendők használatát, mint a szappan, hígított sampon alkalmazását [21,22]. Számos vizsgálat igazolta, hogy több héten át tartó, napi kétszeri alkalmazásuk eredményeképpen szignifikánsan javulnak a klinikai tünetek (a szemhéjszél állapota, gyulladásos jelek, a meibum minősége), illetve a szubjektív panaszok [23][24][25][26][27]. Továbbá már ötnapos kezelést követően is 60%-kal csökken a kötőhártya baktériumflórája [28] [38]. ...
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The onset of dry eye complaints is often a result of Meibomian gland dysfunction and its diagnosis is essential for effective treatment. In the case of Meibomian gland dysfunction, there is an increased evaporation of the tear film due to the abnormal secretion of lipids that cannot spread on the ocular surface. The treatment of dry eye complaints associated with Meibomian gland dysfunction with tear supplementation is usually ineffective and only results in an intermittent relief of complaints. Meibomian gland dysfunction is often associated with Demodex infestation of the eyelids, and eradicating the mites is essential to re-establish normal meibum production and thus, decreasing ocular complaints. In most cases, Meibomian gland dysfunction is mild, and the treatment of these forms is based on ocular hygiene performed by the patient, while only more advanced forms with inflammatory processes require pharmacologic treatment. This review summarizes the most important knowledge on the clinical signs and treatment of Meibomian gland dysfunction with particular attention to the diagnosis and treatment of ocular Demodex infection.
... 15 TTO is derived from the leaves of the Australian native Melaleuca alternifolia tree 121 and contains 15 known ingredients, of which the most abundant is terpinen-4-ol (T4O) which has a strong demodectic affinity. 122 An increasing number of eyelid hygiene products are available to manage Demodex infestation, 123,124 containing either TTO or T4O with varying concentrations. 15,107,125 Linalool, an alcohol which is the primary component of rosewood (Aniba rosaeodora) and Camphor tree (Cinamomon camphora) oils, have also been found to have a strong antimicrobial property including leishmanicidal effects. ...
Article
Demodex is the most common parasite living on humans and yet little is understood about its pathogenicity with respect to the ocular surface. An increasing interest in Demodex over the past 20 years has increased our understanding of this mite and its pathogenetic role. This article begins with a review of the anatomy, life cycle, mode of transmission and advances in genetics that can distinguish between Demodex folliculorum and Demodex brevis, the only two Demodex species in humans. Additionally, a review of diagnostic procedures and existing and emerging ocular and systemic management options are presented. Despite the increasing interest in Demodex in the literature, there remains numerous obstacles for future studies, hence a section of this review is dedicated to the identification and proposal for future considerations. The lack of uniformity with respect to terminology, diagnostic technique and management approach for Demodex remain as obstacles for future study comparisons. This review summarised the current knowledge on Demodex and hopes to offer some recommendations for future directions in the study of Demodex in humans.
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The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
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Purpose: To determine the efficacy and safety of eyelid exfoliation treatment in dry eye disease (DED), blepharitis, and contact lens (CL) discomfort patients. Methods: A systematic review that included only full-length randomized controlled studies, reporting the effects of eyelid exfoliation treatment in 2 databases, PubMed and Web of Science, was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The search period was between October 29, 2022 and December 6, 2022. The Cochrane risk of bias tool was used to analyze the quality of the studies selected. Results: A total of 7 studies were included in this systematic review. Eyelid exfoliation treatment influence on DED, blepharitis, and CL discomfort were analyzed in 6, 4, and 2 studies, respectively. Eyelid exfoliation treatment achieved a better improvement than control group interventions in all reported variables. The mean differences between both groups were as follows: Ocular Surface Disease Index score of -5.0 ± 0.9 points, tear breakup time of 0.43 ± 0.2 seconds, ocular surface staining of -1.4 ± 1.5 points, meibomian glands secretions of 1.2 ± 1.1 points, meibomian glands yielding liquid secretion of 0.6 ± 0.3 points, microorganism load of -3.2 ± 4.7 points, and Contact Lens Dry Eye Questionnaire-8 of -2.15 ± 0.1 points. Minimal discomfort (n = 13) and eyelid irritation (n = 2) were the main complications after an eyelid exfoliation treatment. Conclusions: Eyelid exfoliation is a safe and effective treatment that should be indicated for DED, blepharitis, and CL discomfort.
Article
The multifactorial pathogenesis and interrelationship of blepharitis, meibomian gland dysfunction and dry eye disease poses challenges to any therapeutic approach. Current treatments are mostly palliative, with success limited by perceived inefficacy and poor patient compliance. Castor oil, a natural derivative of the Ricinus communis plant, is widely used as an emollient in cosmetics and personal care products, drug delivery systems and wound dressings. Castor oil is deemed safe and tolerable, with strong anti-microbial, anti-inflammatory, anti-nociceptive, analgesic, antioxidant, wound healing and vaso-constrictive properties. Its main constituent, ricinoleic acid, has a bipolar molecular structure that promotes the formation of esters, amides and polymers. These can supplement deficient physiological tear film lipids, enabling enhanced lipid spreading characteristics and reducing aqueous tear evaporation. Studies reveal that castor oil applied topically to the ocular surface has a prolonged residence time, facilitating increased tear film lipid layer thickness, stability, improved ocular surface staining and symptoms. This review summarises the properties, current uses of, and therapeutic potential of castor oil in managing ocular surface disease. The biochemical, medicinal actions of castor oil are explored from the perspective of ocular surface pathology, and include microbial and demodectic over-colonisation, inflammatory and oxidative processes, as well as clinical signs and symptoms of dryness and discomfort.
Article
Objective Eyelid wipes are routinely recommended for blepharitis, but these do not come without financial cost and potential adverse effects. This review aimed to provide a comprehensive summary of existing evidence for the efficacy and safety of eyelid wipes in the management of blepharitis. Methods A search of Medline and Embase was conducted to identify studies that assessed the efficacy of an eyelid wipe option. Studies that included other interventions were excluded, as well as studies that evaluated warm compresses. Risk of bias, adverse effects, cost, and availability assessments were also performed. Results After the review of 1650 search results, 16 studies were included. A variety of eyelid wipes were studied, including common household products, tea tree oil-based products, commercial solutions, and commercial wipes. Some efficacy was demonstrated for all options that were studied, and most improvements were noted within 1 or 2 months. There was not enough evidence to determine the relative efficacy of different options. There was significant heterogeneity, and all nongeneric options were limited to 1 study, which precluded meta-analysis. The risk of bias assessment revealed concerns regarding the quality of evidence, and notably, several studies were supported by the manufacturing company. Conclusions Although some efficacy has been demonstrated for several types of eyelid wipes, including common household products, there remains a lack of robust evidence to support their routine recommendation. Long-term costs and potential adverse effects should not be overlooked. There is not enough evidence to suggest superiority of one option over others.
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Various treatments are found to be moderately effective in managing Demodex-related diseases except tea tree oil (TTO) and terpinen-4-ol (T4O), which showed superior miticidal and anti-inflammatory effects in numerous clinical studies. Their possible effects include lowering mite counts, relieving Demodex-related symptoms, and modulating the immune system. This review summarizes the current clinical topical and oral treatments in human demodicosis, their possible mechanisms of action, side-effects and resistance in treating this condition. TTO (especially T4O) is found to be the most effective followed by metronidazole, ivermectin and permethrin in managing the disease. This is because TTO has anti-parasitic, anti-bacterial, anti-fungal, anti-inflammatory and wound-healing effects. Furthermore, nanoTTO can even release its contents into fungus and Pseudomonas biofilms. Combinations of different treatments are occasionally needed for refractory cases, especially for individuals with underlying genetic predisposal or are immuno-compromised. Although the current treatments show efficacy in controlling the Demodex mite population and the related symptoms, further research needs to be focused on the efficacy and drug delivery technology in order to develop alternative treatments with better side-effects profiles, less toxicity, lower risk of resistance and are more cost-effective.
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Purpose There is increasing clinical and research interest in the potential contribution of Demodex to ocular surface disease. The aim of this systematic review was to summarise and synthesise current clinical evidence relating to the aetiology, diagnosis and treatment of ocular Demodex . Recent findings A comprehensive literature search was performed in OVID Medline, OVID Embase, and clinical trial registries, for studies published between 1990 and August 2019, examining Demodex on the ocular surface. The review included primary clinical research studies and systematic reviews of primary clinical research studies, where Demodex was considered in the context of the ocular surface and/or adnexa. Studies were categorised using the National Health and Medical Research Council evidence hierarchy. Risk of bias assessment was performed using validated tools for studies categorised as providing Level I or II evidence. A total of 87 studies were eligible for inclusion, including two systematic reviews. Most studies (60%) were observational, describing the prevalence of ocular Demodex in different clinical populations. There was a high degree of variability in the epidemiological data derived from cross‐sectional aetiology studies. There was mostly consistent evidence to support an association between ocular Demodex and chronic blepharitis. Seven diagnostic test‐accuracy studies were identified, which considered a range of techniques, including slit lamp examination for cylindrical eyelash collarettes and/or eyelash manipulation techniques, light microscopic evaluation of epilated eyelashes and in vivo confocal microscopy. There is currently no accepted gold‐standard diagnostic method for ocular Demodex. For intervention studies, there was one systematic review, 11 published randomised trials, six trial registry entries, and nine case series. Despite a number of recent trials, the appropriate treatment regimen for ocular Demodex (including the optimal criteria and timing of an intervention) is not clearly established. Conclusions This comprehensive narrative synthesis has captured the landscape of clinical evidence relating to the prevalence, aetiology, diagnosis and treatment of ocular Demodex . There remain opportunities to enhance understanding of its role in ocular surface disease, best diagnostic approaches and optimal treatment protocols.
Article
Background: Demodex blepharitis is a chronic condition commonly associated with recalcitrant dry eye symptoms though many people with Demodex mites are asymptomatic. The primary cause of this condition in humans is two types of Demodex mites: Demodex folliculorum and Demodex brevis. There are varying reports of the prevalence of Demodex blepharitis among adults, and it affects both men and women equally. While Demodex mites are commonly treated with tea tree oil, the effectiveness of tea tree oil for treating Demodex blepharitis is not well documented. Objectives: To evaluate the effects of tea tree oil on ocular Demodex infestation in people with Demodex blepharitis. Search methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 6); Ovid MEDLINE; Embase.com; PubMed; LILACS; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We used no date or language restrictions in the electronic search for trials. We last searched the databases on 18 June 2019. Selection criteria: We included randomized controlled trials (RCTs) that compared treatment with tea tree oil (or its components) versus another treatment or no treatment for people with Demodex blepharitis. Data collection and analysis: Two review authors independently screened the titles and abstracts and then full text of records to determine their eligibility. The review authors independently extracted data and assessed risk of bias using Covidence. A third review author resolved any conflicts at all stages. Main results: We included six RCTs (1124 eyes of 562 participants; 17 to 281 participants per study) from the US, Korea, China, Australia, Ireland, and Turkey. The RCTs compared some formulation of tea tree oil to another treatment or no treatment. Included participants were both men and women, ranging from 39 to 55 years of age. All RCTs were assessed at unclear or high risk of bias in one or more domains. We also identified two RCTs that are ongoing or awaiting publications. Data from three RCTs that reported a short-term mean change in the number of Demodex mites per eight eyelashes contributed to a meta-analysis. We are uncertain about the mean reduction for the groups that received the tea tree oil intervention (mean difference [MD] 0.70, 95% confidence interval [CI] 0.24 to 1.16) at four to six weeks as compared to other interventions. Only one RCT reported data for long-term changes, which found that the group that received intense pulse light as the treatment had complete eradication of Demodex mites at three months. We graded the certainty of the evidence for this outcome as very low. Three RCTs reported no evidence of a difference for participant reported symptoms measured on the Ocular Surface Disease Index (OSDI) between the tea tree oil group and the group receiving other forms of intervention. Mean differences in these studies ranged from -10.54 (95% CI - 24.19, 3.11) to 3.40 (95% CI -0.70 7.50). We did not conduct a meta-analysis for this outcome given substantial statistical heterogeneity and graded the certainty of the evidence as low. One RCT provided information concerning visual acuity but did not provide sufficient data for between-group comparisons. The authors noted that mean habitual LogMAR visual acuity for all study participants improved post-treatment (mean LogMAR 1.16, standard deviation 0.26 at 4 weeks). We graded the certainty of evidence for this outcome as low. No RCTs provided data on mean change in number of cylindrical dandruff or the proportion of participants experiencing conjunctival injection or experiencing meibomian gland dysfunction. Three RCTs provided information on adverse events. One reported no adverse events. The other two described a total of six participants randomized to treatment with tea tree oil who experienced ocular irritation or discomfort that resolved with re-educating the patient on application techniques and continuing use of the tea tree oil. We graded the certainty of the evidence for this outcome as very low. Authors' conclusions: The current review suggests that there is uncertainty related to the effectiveness of 5% to 50% tea tree oil for the short-term treatment of Demodex blepharitis; however, if used, lower concentrations may be preferable in the eye care arena to avoid induced ocular irritation. Future studies should be better controlled, assess outcomes at long term (e.g. 10 to 12 weeks or beyond), account for patient compliance, and study the effects of different tea tree oil concentrations.
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Purpose: We sought to determine the relative lipase production of a range of ocular bacterial isolates and to assess the efficacy of glycerol monolaurate (GML) in inhibiting this lipase production in high lipase-producing bacteria without affecting bacterial cell growth. Methods: Staphylococcus aureus,Staphylococcus epidermidis,Propionibacterium acnes, and Corynebacterium spp. were inoculated at a density of 106/mL in varying concentrations of GML up to 25 μg/mL for 24 hours at 37°C with constant shaking. Bacterial suspensions were centrifuged, bacterial cell density was determined, and production of bacterial lipase was quantified using a commercial lipase assay kit. Results: Staphylococcus spp. produced high levels of lipase activity compared with P. acnes and Corynebacterium spp. GML inhibited lipase production by Staphylococcal spp. in a dose-dependent manner, with S. epidermidis lipase production consistently more sensitive to GML than S. aureus. Glycerol monolaurate showed significant (P < 0.05) lipase inhibition above concentrations of 15 μg/mL in S. aureus and was not cytotoxic up to 25 μg/mL. For S. epidermidis, GML showed significant (P < 0.05) lipase inhibition above 7.5 μg/mL. Conclusions: Lipase activity varied between species and between strains. Staphylococcal spp. produced higher lipase activity compared with P. acnes and Corynebacterium spp. Glycerol monolaurate inhibited lipase production by S. aureus and S. epidermidis at concentrations that did not adversely affect bacterial cell growth. GML can be used to inhibit ocular bacterial lipase production without proving detrimental to commensal bacteria viability.
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The aim of this study was to determine if Demodex infestation is more frequent in contact lens wearers than in nonwearers. Secondary aims were to evaluate the effects of Demodex on the ocular surface (symptoms and signs) and to evaluate the ability of confocal laser scanning microscopy to detect and quantify the Demodex infestation compared with the conventional light microscopic technique. Forty Asian female participants (20 nonwearers, 20 lens wearers) with a mean (±SD) age of 27 (±9) years were recruited. Ocular comfort scores (Ocular Surface Disease Index, Ocular Comfort Index, and Dry Eye Questionnaire), vital staining (corneal, conjunctival, and lid wiper), tear osmolarity, tear breakup time, and meibomian gland evaluation were evaluated. Demodex was detected using in vivo confocal microscopy and conventional light microscopy. The number of Demodex was higher in lens wearers than in nonwearers (7.6 [±5.8] vs. 5.0 [±3.1]; p = 0.02). Demodex was observed in a large majority (90%) of lens wearers and in 65% of nonwearers using confocal microscopy (p = 0.06). The detection rate was lower in both groups using conventional light microscopy (p = 0.003) where Demodex could only be confirmed in 70% and 60% of lens wearers and nonwearers, respectively. The number of Demodex tended to increase with age (ρ = 0.28, p = 0.08), but Demodex did not appear to affect ocular comfort or any clinical signs (p > 0.05). Contact lens wearers harbor Demodex as frequently as nonwearers and in higher numbers, which is best detected using in vivo confocal microscopy. The significance of these findings is uncertain because no associations were found with any symptoms and signs of dry eye disease.
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Dry eye is the most common ocular morbidity found in elderly patients. There is no gold standard/standard test for diagnosing dry eye. The present study was conducted to compare the potential of Phenol Red Thread (PRT) test versus Schirmer Test in diagnosing dry eye. The study was conducted on 50 patients, aged 40 years and above. History of dry eye symptoms was taken and the symptoms were graded. Six-questions Bandeen Rosch questionnaire was administered to those having symptoms of dry eye. Patients whose response to any of the questions was often/all the time were included in the study. After performing standard clinical examination, Schirmer and PRT tests were done. PRT is equally sensitive in detecting dry eye, and in addition, it has many advantages as compared to Schirmer. PRT is simpler and more comfortable to the patient and can be done in children. It causes less reflex tearing. Most important is the lesser time consumed (15 seconds) in comparison to Schirmer (5 minutes). Kappa value between PRT and Schirmer was found to be 0.96 in this study and shows a strong agreement between the two. So, PRT can be considered equally good in detecting dry eye.
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The purpose of this study was to evaluate the relation between ocular discomfort and ocular Demodex infestation, and therapeutic effects of tea tree oil (TTO) in Demodex blepharitis patients. Three hundred and thirty-five patients with ocular discomfort were evaluated for ocular Demodex infestation and subjective symptoms with ocular surface discomfort index (OSDI) score. Among them, Demodex-infested patients were randomized to receive either eyelid scrubbing with TTO (TTO group,106 patients) or without TTO (Control group, 54 patients) for 1 month. Demodex were found in 84% of patients with ocular discomfort. The number of Demodex was significantly correlated with age (P = 0.04) and OSDI score (P = 0.024). After eyelid scrub treatment, Demodex count was reduced from 4.0 ± 2.5 to 3.2 ± 2.3 in the TTO group (P = 0.004) and from 4.3 ± 2.7 to 4.2 ± 2.5 in the control group (P = 0.27). Also, OSDI score was reduced from 34.5 ± 10.7 to 24.1 ± 11.9 in the TTO group (P = 0.001) and from 35.3 ± 11.6 to 27.5 ± 12.8 in the control group (P = 0.04). In conclusion, Demodex number showed a significant positive correlation with age and subjective ocular discomfort. The tea tree oil eyelid scrub treatment is effective for eliminating ocular Demodex and improving subjective ocular symptoms.
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The goals of the subcommittee were to review the current practice and published evidence of medical and surgical treatment options for meibomian gland dysfunction (MGD) and to identify areas with conflicting, or lack of, evidence, observations, concepts, or even mechanisms where further research is required. To achieve these goals, a comprehensive review of clinical textbooks and the scientific literature was performed and the quality of published evidence graded according to an agreed on standard, using objective criteria for clinical and basic research studies adapted from the American Academy of Ophthalmology Practice Guidelines1 (Table 1). It should be noted that, in many of the clinical textbooks and previous reports, terminology is often interchanged and the management of anterior and posterior blepharitis and/or meibomitis is often considered concurrently. Thus, a broad scope of documents was reviewed in this process. Consistency in terminology and global adoption of the term “meibomian gland dysfunction” would significantly aid clinical research and clinical care in MGD going forward.
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To validate a subset of Dry Eye Questionnaire (DEQ) items that discriminate across self-assessed severity and various diagnoses of dry eye (DE). Subjects (n=260) in 2 studies received a clinical DE diagnosis, completed the 6-page DEQ and self-assessment of DE severity (SA-Sev). SA-Sev ratings were: 46 Severe, 107 Moderate, 77 Mild, and 46 None. Dry eye diagnoses were: 48 asymptomatic controls (C), 155 non-SS KCS, and 57 Sjögren Syndrome (SS). All DEQ items were correlated to SA-Sev by Spearman. Groups of highly correlated DEQ items were tested to discriminate SA-Sev; and the subset tested to distinguish across DE diagnosis. The DEQ-5 comprises: frequency of watery eyes (r=0.48), discomfort (r=0.41), and dryness (r=0.35), and late day (PM) intensity of discomfort and dryness (r=0.42, 0.36) all significantly correlated to SA-Sev (p<0.01). Mean DEQ-5 scores by SA-Sev: Severe 14.9+/-2.3, Moderate 11.4+/-3.3, Mild 8.6+/-3.1 and None 2.7+/-3.2 (ANOVA, p<0.0001) and by DE diagnosis: C 2.7+/-2.9, non-SS KCS10.5+/-4.5 and SS14.0+/-3.4, differing significantly overall (Z=-8.6, p=0.000) and between diagnoses (X(2)=116.3, p=0.000). Watery eyes were reported primarily by non-SS KCS. Proposed screening criteria for the DEQ-5 are >6 for DE and >12 for suspected SS. The DEQ-5, the sum of scores for frequency and PM intensity of dryness and discomfort plus frequency of watery eyes, effectively discriminated across self-assessed severity ratings and between patients with DE diagnoses. These results indicate that DEQ-5 scores >6 suggest DE and scores >12 may indicate further testing to rule out SS-DE.
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To assess the minimal clinically important difference (MCID) for the Ocular Surface Disease Index (OSDI; Allergan Inc, Irvine, California, holds the copyright), a 12-item patient-reported outcome questionnaire designed to quantify ocular disability due to dry eye disease. Study data were collected within the Restasis Review of Efficacy and Safety vs Tears in the Relief of Dry Eye (RESTORE), an observational registry. A clinician global impression (CGI) and a subject global assessment (SGA) served as anchors to estimate the MCID for the overall OSDI score (range, 0-100). The overall OSDI score defined the ocular surface as normal (0-12 points) or as having mild (13-22 points), moderate (23-32 points), or severe (33-100 points) disease. RESTORE patients were included if they completed the OSDI at the baseline visit and at a follow-up visit and had a global change rating (SGA or CGI). Three hundred ten patients were included (82.3% white and 81.6% female [mean age, 57.8 years]). The CGI and SGA correlated with the OSDI score change for all OSDI categories except the normal category. The MCID ranged from 7.0 to 9.9 for all OSDI categories. The MCID ranged from 4.5 to 7.3 for mild or moderate disease and from 7.3 to 13.4 for severe disease. Using observational data, we estimated the MCIDs for different baseline OSDI categories of dry eye disease. These results will assist clinicians and researchers when interpreting OSDI score changes.
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Atopic dermatitis (AD) skin is dry and readily colonized by Staphylococcus aureus (SA). Coconut and olive oils are traditionally used to moisturize and treat skin infections. To compare virgin coconut oil (VCO) and virgin olive oil (VOO) in moisturizing dryness and removing SA from colonized AD skin. This was a double-blind controlled trial in two outpatient dermatology clinics with adult AD patients who were diagnosed by history, pattern, evolution, and skin lesions and who were randomized to apply VCO or VOO twice daily at two noninfected sites. SA cultures, photography, and objective-SCORAD severity index (O-SSI) scoring were done at baseline and after 4 weeks. Twenty-six subjects each received VCO or VOO. Of those on VCO, 20 were positive for SA colonies at baseline versus 12 on VOO. Post intervention, only 1 (5%) VCO subject remained positive versus 6 (50%) of those on VOO. Relative risk for VCO was 0.10, significantly superior to that for VOO (10:1, p = .0028; 95% CI, 0.01-0.73); thus, the number needed to treat was 2.2. For the O-SSI, the difference was not significant at baseline (p = .15) but was significantly different post treatment (p = .004); this was reduced for both oils (p < .005) but was greater with VCO. VCO and monolaurin's O-SSI reduction and in vitro broad-spectrum activity against SA (given clinical validity here), fungi, and viruses may be useful in the proactive treatment of AD colonization.
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Glycerol monolaurate (GML) is a naturally occurring surfactant that has potential use as an additive to tampons and wound dressings to reduce the incidence of certain bacterial toxin-mediated illnesses. In vitro studies were undertaken to evaluate the effect of GML on the growth of and toxin production by potentially pathogenic bacteria. GML inhibited the growth of clinical isolates of group A, B, F, and G streptococci at concentrations of 10 to 20 micrograms/ml. Exotoxin production, including that of pyrogenic exotoxins and hemolysins, was reduced by concentrations of GML that were below those inhibitory for growth as well as growth inhibitory. The growth of Staphylococcus aureus strains from patients with toxic shock syndrome and scalded skin syndrome was inhibited or delayed in the presence of 100 to 300 micrograms of GML per ml. Growth inhibition by GML could be overcome by the production of lipase. S. aureus elaboration of hemolysin, toxic shock syndrome toxin 1, and exfoliative toxin A was inhibited at GML concentrations below those necessary to inhibit growth. Results similar to those for S. aureus were obtained in tests of S. hominis. Escherichia coli growth and Salmonella minnesota growth were unaffected by GML, but an S. minnesota Re mutant was susceptible to growth-inhibitory activity. Endotoxin release into the medium from E. coli cells was also unaffected by GML, but the release or activity of E. coli hemolysin was increased by GML. Streptococcal pyrogenic endotoxin A production by an E. coli clone was not affectd by GML. These studies indicate that GML is effective in blocking or delaying the production of exotoxins by pathogenic gram-positive bacteria.
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We report on a patient who had an excessive number of mites (Demodex folliculorum) on his eye lashes, i.e. 10 mites on eight lashes examined. A review of three previous reports suggested that one mite for every two lashes represents an over population of this nearly ubiquitous mite. Greasy scales on the lashes and foamy tears suggested that seborrhea was present as well as demodicosis. The primary symptoms of itching was relieved after one week of treatment with mercuric oxide ointment and lid scrubs, although the number of mites was not reduced. Treatment for an additional two weeks did reduce the mite number. We therefore recommend continuing treatment for demodicosis for at least three weeks even if symptoms abate sooner.
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Glycerol monolaurate (GML) inhibits the expression of virulence factors in Staphylococus aureus and the induction of vancomycin resistance in Enterococcus faecalis, presumably by blocking signal transduction. Although GML is rapidly hydrolyzed by bacteria, one of the products, lauric acid, has identical inhibitory activity and is metabolized much more slowly. At least four distinct GML-hydrolyzing activities are identified in S. aureus: the secreted Geh lipase, residual supernatant activity in ageh-null mutant strain, a novel membrane-bound esterase, and a cytoplasmic activity.
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To determine the prevalence of Demodex in eyelashes with cylindrical dandruff (CD). A modified sampling and counting method was applied to 55 clinical cases. Patients were divided in to group A (n = 20) with diffuse CD, group B (n = 12) with sporadic CD, and group C (n = 23) with clean lashes or greasy scales, of which the latter was divided into subgroup C1 (n = 15) without lid hygiene and subgroup C2 (n = 8) using daily lid hygiene for the past year. Each patient underwent a routine complete eye examination and modified counts of Demodex. Demodex was found in all group A and B patients (n = 32) with CD, which was significantly higher than the 22% of group C patients (n = 23) without CD (P < 0.001). The Demodex counts were 4.1 +/- 1.0 and 2.0 +/- 1.2 per epilated lash with retained CD, significantly higher than the 0.2 +/- 0.5 and 0.2 +/- 0.4 per lash without retained CD in groups A and B, respectively (each P < 0.001) and than the 0.01 +/- 0.09 and 0.12 +/- 0.41 per lash in subgroups C1 and C2, respectively (each P < 0.001). Demodex was still found in CD fragments left on the lid skin after epilation. Five Demodex brevis mites were found among the 422 Demodex specimens. The modified sampling and counting method showed that the prior controversy regarding Demodex has resulted from miscounting and confirmed that lashes with CD are pathognomonic for ocular Demodex infestation. Lid hygiene with shampoo reduces Demodex counts but does not eradicate the mites.
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To compare the in vitro killing effect of different agents on Demodex and to report the in vivo killing effect of tea tree oil (TTO) on ocular Demodex. Survival time of Demodex was measured under the microscope. Sampling and counting of Demodex was performed by a modified method. Demodex folliculorum survived for more than 150 minutes in 10% povidone-iodine, 75% alcohol, 50% baby shampoo, and 4% pilocarpine. However, the survival time was significantly shortened to within 15 minutes in 100% alcohol, 100% TTO, 100% caraway oil, or 100% dill weed oil. TTO's in vitro killing effect was dose dependent. Lid scrub with 50% TTO, but not with 50% baby shampoo, can further stimulate Demodex to move out to the skin. The Demodex count did not reach zero in any of the seven patients receiving daily lid scrub with baby shampoo for 40-350 days. In contrast, the Demodex count dropped to zero in seven of nine patients receiving TTO scrub in 4 weeks without recurrence. Demodex is resistant to a wide range of antiseptic solutions. Weekly lid scrub with 50% TTO and daily lid scrub with tea tree shampoo is effective in eradicating ocular Demodex.
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Synopsis Glycerin is widely used in cosmetics and well as in pharmaceutical formulations, mainly as humectant. In vitro studies have shown glycerin to prevent crystallization of stratum corneum model lipid mixture at low room humidity. Whether this may affect the skin barrier function during repeated application of glycerin in a cream base to normal skin is not known. Therefore, the influence of a cream containing 20% glycerin was compared with its placebo cream in a bilateral, double‐blind study on 17 healthy volunteers. The effect was evaluated as influence on hydration with a corneometer and on skin barrier function. Skin barrier function was assessed as permeability to water with an evaporimeter (transepidermal water loss; TEWL) and as sensitivity to an irritating surfactant by measuring the biological response (measured as TEWL and skin blood flow). Ten days treatment of normal skin with 20% glycerin significantly increased skin corneometer values, indicating an increased hydration. However, our study failed to show an influence of glycerin on human skin, in terms of TEWL and skin sensitivity to SLS‐induced irritation. Résumé La glycérine est largement utilisée dans les formulations cosmétiques aussi bien que pharmaceutiques, principalement en tant qu’humectant. Des tests in vitro ont montré que la glycérine empèche la cristallization de la structure lipidique du Stratum Corneum à humidité ambiante basse. La question de savoir si ceci peut affecter la fonction barrière de la peau durant des applications répetées d’une crème pour peau normale contenant de la glycérine n’a pas été demontrée. Par conséquent, une crème contenant 20% de glycérine a été comparée avec son placebo dans un test bilatéral en double aveugle sur 17 volontaires en bonne santé. L’effet hydratant de la glycérine a étéévalué avec l’aide d’un cornéomètre, son influence sur la fonction barrière de la peau avec l’aide d’un évaporimètre (mesurant la Perte Trans‐Epidermal en eau) et son effet protecteur après irritation á l’aide d’un agent de surface par la réponse biologique de la peau (mesure de la PTEL et du flux sanguin). Dix jours de traitement sur une peau normale avec une crème contenant 20% de glycérine ont augmenté les mesures du cornéomètre de manière significative, indiquant une augmentation de l’hydration de la peau. Cependant notre étude n’a pas pu démontré l’influence de la glycérine sur la peau en terme de PTEL et la réduction du potentiel irritant du Sodium Lauryl Sulphate.
Article
Purpose: To compare the efficacy of Dr Organic Tea Tree Face Wash, OcuSoft Lids Scrub Plus and the BlephEx™ device at treating of Demodex folliculorum blepharitis. Methods: Eighty-six subjects (33 males/36 females) were enrolled in a randomised controlled interventional treatment study. Subjects completed a dry eye symptom questionnaire and were assessed for presence of Demodex folliculorum. Subjects were divided into three groups according to treatment: Dr Organic Tea Tree Face Wash (A) (n=28), OcuSoft Lid Scrub Plus (B) (n=30), or in-house lid scrub with the BlephEx™ device before nightly lid scrubs with OcuSoft Lid Scrub Plus (C) (n=28). Subjects were advised to clean their eyelids nightly for four weeks. Each subject was re-assessed for symptoms and Demodex folliculorum blepharitis after two weeks and four weeks of treatment. Results: The quantity of Demodex folliculorum was significantly reduced after four weeks of treatment in all three groups (p<0.05). Overall, there was no difference in efficacy between the three treatments (p>0.1). Symptoms reported by subjects were significantly improved after two and four weeks of treatment (p<0.05). Overall, there was no difference in efficacy between the three treatments to reduce symptoms after two or four weeks (p= 0.813 and p=0.646 respectively). Conclusion: All three methods tested have shown good ability to reduce Demodex folliculorum quantity, improve subjective symptoms and help treat Demodex folliculorum blepharitis.
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The members of the Management and Therapy Subcommittee undertook an evidence-based review of current dry eye therapies and management options. Management options reviewed in detail included treatments for tear insufficiency and lid abnormalities, as well as anti-inflammatory medications, surgical approaches, dietary modifications, environmental considerations and complementary therapies. Following this extensive review it became clear that many of the treatments available for the management of dry eye disease lack the necessary Level 1 evidence to support their recommendation, often due to a lack of appropriate masking, randomization or controls and in some cases due to issues with selection bias or inadequate sample size.
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The role of the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II Diagnostic Methodology Subcommittee was 1) to identify tests used to diagnose and monitor dry eye disease (DED), 2) to identify those most appropriate to fulfil the definition of DED and its sub-classifications, 3) to propose the most appropriate order and technique to conduct these tests in a clinical setting, and 4) to provide a differential diagnosis for DED and distinguish conditions where it is a comorbidity. Symptom screening with the DEQ-5 or OSDI confirms that a patient might have DED and triggers the diagnostic tests of (ideally non-invasive) breakup time, osmolarity and ocular surface staining with fluorescein and lissamine green (observing the cornea, conjunctiva and eyelid margin). Prior to diagnosis, it is important to exclude conditions that can mimic DED with the aid of triaging questions. Meibomian gland dysfunction, lipid thickness/dynamics and tear volume assessment and their severity allow sub-classification of DED (predominantly evaporative or aqueous deficient) which informs the management of DED. Videos of these diagnostic and sub-classification techniques are available on the TFOS website. It is envisaged that the identification of the key tests to diagnose and monitor DED and its sub-classifications will inform future epidemiological studies and management clinical trials, improving comparability, and enabling identification of the sub-classification of DED in which different management strategies are most efficacious.
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To the Editor.— Demodex mites are parasites normally present in human skin. In up to 10% of skin biopsy samples, these organisms can be seen as an incidental finding colonizing the pilosebaceous complex.1 It is well known that the greatest concentration of Demodex is found in areas where sebaceous glands are numerous and sebum production is pronounced.2 Aylesworth and Vance1 demonstrated that the face is by far the most heavily infested area, especially the temple and the nasal region. To a lesser degree, Demodex have been found around nipples, neck, chest, back, and genital regions.3 An isolated report has shown the presence of Demodex in ectopic sebaceous glands of the oral mucosa.4 This observation suggests that Demodex has an affinity for the sebaceous glands, and that hair follicles need not be present for the mites' survival.Materials and Methods.— Formaldehyde-fixed paraffin-embedded sections from a consecutive series
Article
For many years Demodex folliculorum has been recognized as an inhabitant of the pores of the skin, particularly in the face. Except for a detailed study by Stcherbatchoff in 1903, only casual reference has been made to its presence in the eyelid structures of man. Freshly collected material from the pores and eyelashes, placed in glycerin, can be examined readily under the low power microscope for the presence of the organism. In some patients the association of a Demodex infection of the eyelids and blepharitis appear to be associated etiologically. Satisfactory, if not ideal, eyelid treatment has been devised through the careful use of Selsunef ointment.* Concurrent treatment of Demodex infestation of the face is imperative to prevent reinfection of the eyelash structures.
Article
Objective To evaluate the validity and reliability of the Ocular Surface Disease Index (OSDI) questionnaire.Methods Participants (109 patients with dry eye and 30 normal controls) completed the OSDI, the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25), the McMonnies Dry Eye Questionnaire, the Short Form-12 (SF-12) Health Status Questionnaire, and an ophthalmic examination including Schirmer tests, tear breakup time, and fluorescein and lissamine green staining.Results Factor analysis identified 3 subscales of the OSDI: vision-related function, ocular symptoms, and environmental triggers. Reliability (measured by Cronbach α) ranged from good to excellent for the overall instrument and each subscale, and test-retest reliability was good to excellent. The OSDI was valid, effectively discriminating between normal, mild to moderate, and severe dry eye disease as defined by both physician's assessment and a composite disease severity score. The OSDI also correlated significantly with the McMonnies questionnaire, the National Eye Institute Visual Functioning Questionnaire, the physical component summary score of the Short Form-12, patient perception of symptoms, and artificial tear usage.Conclusions The OSDI is a valid and reliable instrument for measuring the severity of dry eye disease, and it possesses the necessary psychometric properties to be used as an end point in clinical trials.
Article
Sodium laureth sulfate (SLES) is an anionic detergent, which has been used globally for personal care products because of its mildness and good foaming ability. However, SLES is somewhat invasive and stimulatory to the skin and many consumers with sensitive skin desire milder detergents for daily use skin cleansers. We enhanced the mildness of SLES by formulating it with sodium laureth carboxylate (AEC) and lauryl glucoside (LG). In skin soak tests, 5% detergent solutions were applied to the forearms of 10 Japanese healthy volunteers for 30 min followed by washing with tap water once a day for 4 days. Twenty-four hr after the last treatment, cutaneous capacitance measurements and visual analyses were performed. In a controlled usage study, 16 Japanese healthy volunteers used the test body cleanser for 4 weeks. Assessment of efficacy and mildness was conducted prior to the start of the study and at the end of week 4 by cutaneous conductance, dermoscopic evaluation of the stratum corneum, and visual assessment by a dermatologist. In soak tests, cutaneous capacitance was significantly decreased on the soap-treated region and on the SLES-treated region. No significant decrease was identified on the SLES/AEC/LG-treated region with less induction of erythema or dryness. In the controlled usage study, no significant changes in cutaneous conductance or texture or damage of corneocytes on the forearm and lower thigh were found. However, visual assessment revealed a significant decrease in scaling and erythema on the lower thigh after 4 weeks of usage with an improvement of the discomfort of the consumer. The favorability rating of this formulated detergent in several questionnaire items was very good. The newly formulated skin cleanser with the combination of anionic surfactants SLES and AEC and the nonionic surfactant LG provides a mild surfactant with a satisfactory cleansing activity for body washing. This article is protected by copyright. All rights reserved.
Article
Purpose. To evaluate the frequency level and profile of contact lens storage case contamination in asymptomatic contact lens wearers and to examine whether different areas of the same lens case may show a different rate and profile of contamination. The relationship between lens storage case contamination and the age of the lens storage case was also examined. Methods. Sixty-four lens cases and case age information were collected from asymptomatic contact lens wearers. Lens cases were sampled at two locations, the upper rim and the lower base. The samples underwent microbiological investigation for recovery of bacteria and fungi. Contamination rate between the two sampling locations and the relationship between the contamination levels and the age of the lens case were analyzed. Results. Contamination occurred in 58% (37 of 64) of lens cases. The most frequently recovered microorganisms were coagulase-negative Staphylococci (51%, 19 of 37), Bacillus spp. (43%,16 of 37), and fungi (27%,10 of 37). For flat-well lens cases, higher numbers of microorganisms were recovered from the upper rim than that from the lower base (p = 0.02), and a greater variety of Gram-negative bacteria were recovered from the upper rim. A higher recovery rate of Micrococcus spp. (p = 0.02; in flat cases) and coagulase-negative Staphylococci (p = 0.01; for both flat and basket type cases) was found from the base of the case well compared with the upper rim. For stand-up cases, higher numbers of microorganisms were recovered from the lens basket compared to the upper hinge (p = 0.047). Lens cases that were <9 months of age had lower levels of contamination (p = 0.013) than older cases. Conclusions. Frequent replacement of lens cases may reduce microbial contamination. Future studies should specify the areas swabbed in the lens case. Better lens storage case design and additional hygiene attention need to be introduced to reduce contamination in these “risky” areas.
Article
The principal objective of this investigation was to assess the symptomatic relief associated with eyelid hygiene using Blephaclean eye pads, a cosmetic product, to manage anterior blepharitis or Meibomian gland dysfunction (MGD) associated with dry eye complaints. The investigation was a bilateral, prospective, interventional open label investigation of 3-month duration. The test population was made up of dry eye sufferers with at least mild symptoms (Ocular Surface Disease Index [OSDI] ≥13) who presented with mild to moderate anterior blepharitis or MGD. Eyelid hygiene was intensive (twice a day) for the initial 3 weeks and a maintenance regimen (once a day) for the remainder of the study. At each visit, a detailed assessment of symptomatology was carried out. The assessment included the reporting of overall symptomatology with the OSDI questionnaire, of comfort and specific symptoms at the end of the day on 100-point visual analog scales and of specific MGD-related symptoms on forced choice 5-point scales. Forty subjects aged 22 to 74 years (54±15 years) were enrolled, of whom 39 completed the investigation. The product usage revealed good overall compliance throughout the study. The results revealed significant improvement in symptomatology. A significant (P<0.001) decrease in overall symptomatology was recorded (Mean OSDI: baseline=30, day 21=18, day 90=19; Symptomatic status: baseline 100%, day 21 55%, day 90 54%) associated with significant (P<0.001) increase in the end of day comfort (Mean score: baseline=56, day 21=67, day 90=67) and decrease in end of day dryness (Mean score: baseline=55, day 21=42, day 90=41). The results showed that eyelid hygiene with Blephaclean wipes by subjects with anterior blepharitis or MGD significantly decreased their associated symptomatology and increased their ocular comfort. The data confirmed the efficiency of the clinical methodology, put forward of 3 weeks of intensive use (twice a day) of eyelid wipes followed by maintenance use (once a day); that approach achieved a rapid symptomatic improvement that was maintained over time.
Article
A study on the commercial virgin coconut oil (VCO) available in the Malaysian and Indonesian market was conducted. The paper reported the chemical characteristics and fatty acid composition of VCO. There was no significant difference in lauric acid content (46.64–48.03%) among VCO samples. The major triacylglycerols obtained for the oils were LaLaLa, LaLaM, CLaLa, LaMM and CCLa (La, lauric; C, capric; M, myristic). Iodine value ranged from 4.47 to 8.55, indicative of only few unsaturated bond presence. Saponification value ranged from 250.07 to 260.67mg KOH/g oil. The low peroxide value (0.21–0.57mequiv oxygen/kg) signified its high oxidative stability, while anisidine value ranged from 0.16 to 0.19. Free fatty acid content of 0.15–0.25 was fairly low, showing that VCO samples were of good quality. All chemical compositions were within the limit of Codex standard for edible coconut oil. Total phenolic contents of VCO samples (7.78–29.18mg GAE/100g oil) were significantly higher than refined, bleached and deodorized (RBD) coconut oil (6.14mg GAE/100g oil). These results suggest that VCO is as good as RBD coconut oil in chemical properties with the added benefit of being higher in phenolic content.
Article
To determine whether ocular itching associated with ocular demodicosis can be treated by lid massage with 5% tea tree oil ointment (TTOO). Twenty-four patients with ocular itching and ocular Demodex were treated with chlortetracycline hydrochloride eye ointment lid massage for 4 weeks and then treatment was switched to TTOO for another 4 weeks. They were examined every 2 weeks and their itching was graded as 0 (none), 1 (mild), 2 (moderate), or 3 (severe). Changes of itching scores and Demodex counts were compared. Before the treatment, all 24 patients reported itching graded as 1 (n = 3), 2 (n = 15), and 3 (n = 6) for a period of 2 weeks to 2 years despite previous topical antibiotics, antiinflammatory medications, or antiallergy medications. Demodex counts per 8 epilated lashes were 5.5 ± 1.6 for all patients but 4.6 ± 1.5, 4.8 ± 1.9, and 7.1 ± 2.1 for patients with grade 1, grade 2, and grade 3 itchiness, respectively (P < 0.05 between grade 2 and grade 3). After 4 weeks of chlortetracycline hydrochloride eye ointment treatment, little changes were observed regarding itching and Demodex counts in all patients (P > 0.05). In contrast, after 5% TTOO treatment, 16 patients were totally free of itching and the remaining 8 patients had different degrees of relief (P < 0.01). The Demodex count decreased to 0.7 ± 0.8 for total (P < 0.01). There is a strong correlation between ocular itching and Demodex infestation and between symptomatic resolution and reduction of Demodex counts by daily lid massage with 5% TTOO.
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Cocamidopropyl betaine (CAPB) is an amphoteric synthetic detergent that has been increasingly used in cosmetics and personal hygiene products (eg, shampoos, contact lens solutions, toothpaste detergents, makeup removers, bath gels, skin care products, cleansers, liquid soaps, antiseptics, and gynecologic and anal hygiene products) because it induces relatively mild skin irritation. Delayed T-cell-mediated type IV hypersensitivity reactions to CAPB have been reported, and contact sensitization prevalence is estimated at between 3.0 and 7.2%. The increasing rates of sensitization led to CAPB's being named Allergen of the Year in 2004. Related impurities rendered during the manufacturing process (such as amidoamine and dimethylaminopropylamine) are thought to play a role in sensitization.
Article
The use of unidimensional pain scales such as the Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), or Visual Analogue Scale (VAS) is recommended for assessment of pain intensity (PI). A literature review of studies specifically comparing the NRS, VRS, and/or VAS for unidimensional self-report of PI was performed as part of the work of the European Palliative Care Research Collaborative on pain assessment. To investigate the use and performance of unidimensional pain scales, with specific emphasis on the NRSs. A systematic search was performed, including citations through April 2010. All abstracts were evaluated by two persons according to specified criteria. Fifty-four of 239 papers were included. Postoperative PI was most frequently studied; six studies were in cancer. Eight versions of the NRS (NRS-6 to NRS-101) were used in 37 studies; a total of 41 NRSs were tested. Twenty-four different descriptors (15 for the NRSs) were used to anchor the extremes. When compared with the VAS and VRS, NRSs had better compliance in 15 of 19 studies reporting this, and were the recommended tool in 11 studies on the basis of higher compliance rates, better responsiveness and ease of use, and good applicability relative to VAS/VRS. Twenty-nine studies gave no preference. Many studies showed wide distributions of NRS scores within each category of the VRSs. Overall, NRS and VAS scores corresponded, with a few exceptions of systematically higher VAS scores. NRSs are applicable for unidimensional assessment of PI in most settings. Whether the variability in anchors and response options directly influences the numerical scores needs to be empirically tested. This will aid in the work toward a consensus-based, standardized measure.
Article
To summarize the key literature and our research experience regarding Demodex infestation as a potential cause of ocular inflammatory diseases with a special emphasis on Demodex blepharitis. Two distinct Demodex species have been confirmed as a cause of blepharitis: Demodex folliculorum can cause anterior blepharitis associated with disorders of eyelashes, and D. brevis can cause posterior blepharitis with meibomian gland dysfunction and keratoconjunctivitis. Tea tree oil treatments with either 50% lid scrubs or 5% lid massages are effective in eradicating mites and reducing ocular surface inflammation. Demodex blepharitis is a common but overlooked external eye disease. The pathogenesis of Demodex blepharitis in eliciting ocular surface inflammation has been further clarified. The modified eyelash sampling and counting method makes it easier and more accurate to diagnose Demodex infestation. Tea tree oil shows promising potential to treat Demodex blepharitis by reducing Demodex counts with additional antibacterial, antifungal, and anti-inflammatory actions.
Article
This study investigated some pharmacological properties of virgin coconut oil (VCO), the natural pure oil from coconut [Cocos nucifera Linn (Palmae)] milk, which was prepared without using chemical or high-heat treatment. The anti-inflammatory, analgesic, and antipyretic effects of VCO were assessed. In acute inflammatory models, VCO showed moderate anti-inflammatory effects on ethyl phenylpropiolate-induced ear edema in rats, and carrageenin- and arachidonic acid-induced paw edema. VCO exhibited an inhibitory effect on chronic inflammation by reducing the transudative weight, granuloma formation, and serum alkaline phosphatase activity. VCO also showed a moderate analgesic effect on the acetic acid-induced writhing response as well as an antipyretic effect in yeast-induced hyperthermia. The results obtained suggest anti-inflammatory, analgesic, and antipyretic properties of VCO.
Article
To determine the correlative relationship between the prevalence of Demodex in eyelashes and the severity of ocular discomfort, by investigating the demographic epidemiology associated with Demodex. One hundred seventy patients underwent epilation of four eyelashes of each eye, and the number of Demodex was counted. The patients answered questionnaires about ocular surface discomfort and underwent ophthalmic examinations, including slit lamp, tear film breakup time (BUT), Schirmer test, and microbial culturing. The correlative relationship between the number of Demodex and these variable data was analyzed. Demodex was found in 120 (70%) of the 170 tested patients. Of 1360 eyelashes, 740 (54%) had Demodex. There was no significant difference in the prevalence of Demodex between males and females (P = 0.35). The number of Demodex showed significant positive correlations with increased age, ocular discomfort, and 1/BUT (P < 0.001), but not with the Schirmer scores. The number of Demodex was significantly higher in patients with conjunctival papillary hypertrophy than in those without (P = 0.003). The presence or distribution of bacteria on eyelashes was similar between eyelids with and without Demodex. However, methicillin-resistant Staphylococcus aureus (MRSA) was detected more often on eyelids with Demodex, but this difference was not statistically significant. There is a strong correlation between the number of Demodex and the severity of ocular discomfort, suggesting that Demodex plays a pathogenic role in the ocular discomfort linked with aging.
Article
Tetracycline administered in low doses can be effective in the long-term management of patients with meibomian keratoconjunctivitis (MKC). However, the mechanism of action does not appear to be a reduction of bacteria. Seventy-five percent of the ocular staphylococci in such patients are resistant to tetracycline. An alternative mechanism of action could be the inhibition of production of extracellular enzymes by the ocular flora. Inhibition of lipase production could result in lowered levels of toxic hydrolysis products (free fatty acids), which may exacerbate the disease process. The authors tested this hypothesis by examining the differential effect of tetracycline on growth and lipase production in a tetracycline-resistant and tetracycline-sensitive strain of Staphylococcus epidermidis and S. aureus isolated from patients with MKC and Staphylococcal blepharitis. Tetracycline caused significant decreases in the production of lipase in the sensitive and resistant strains of S. epidermidis without concominant decreases in growth. In contrast, S. aureus strains showed parallel decreases in both lipase production and inhibition of growth. The authors propose that the sensitivity of lipase production to tetracycline, in tetracycline-resistant S. epidermidis, may partially explain the clinical improvement observed in MKC patients.
Article
The microbiologic evaluations of 332 consecutive patients with the primary diagnosis of chronic blepharitis were reviewed and compared to those of 160 control patients. The most commonly isolated organisms from lids with blepharitis were Staphylococcus epidermidis (95.8%), Propronibacterium acnes (92.8%), Corynebacterium sp. (76.8%), Acinetobacter sp. (11.4%), and Staphylococcus aureus (10.5%). Compared to controls, S. epidermidis (p less than 0.01), P. acnes (p less than 0.02), and Corynebacterium sp. (p less than 0.001) were present significantly more often. S. aureus and the isolation of more than one microbial species were not more common in blepharitis patients. Quantitatively, heavy growth, by total and individual species, was significantly more common in blepharitis patients (total, p less than 0.001; S. epidermidis, p less than 0.001, P. acnes, p less than 0.001). These data demonstrate that patients with blepharitis are more likely to have normal skin bacteria on their lids and in greater quantities than nonblepharitis patients.
Article
Eyelids and conjunctivae of 36 normal individuals and 60 patients from six clinical groups of chronic blepharitis were cultured for aerobic and anaerobic bacteria. The most common species isolated were coagulase-negative staphylococci (C-NS) and Propionibacterium acnes. All strains of these species, and all Staphylococcus aureus strains isolated were tested for the ability to break down triglycerides, cholesterol esters, and fatty waxes. Each strain was incubated independently with appropriate substrates in nutrient media. Each medium was then extracted and assayed for the presence of substrate hydrolysis products by thin-layer chromatography. The percentage of strains capable of hydrolyzing a particular substrate was determined for each individual. S. aureus was a consistent and strong lipase producer, able to hydrolyze all three substrates. P. acnes was able to hydrolyze triolein and behenyl oleate but not cholesteryl oleate. No differences were observed among groups for P. acnes or S. aureus. C-NS showed a high degree of strain variability. Eighty-three percent of C-NS strains could hydrolyze triolein, 82% behenyl oleate, and 40% cholesteryl oleate. Significant group differences were seen in the percentage of lipase positive C-NS strains isolated per individual. Patients in the mixed staphylococcal/seborrheic, meibomian seborrheic, secondary meibomitis, and the meibomian keratoconjunctivitis (MKC) groups harbored significantly more C-NS strains capable of hydrolyzing cholesteryl oleate than did normal individuals. Patients in the meibomian seborrheic, secondary meibomitis, and MKC groups harbored significantly more C-NS strains capable of hydrolyzing behenyl oleate than did normals. No group differences were seen among groups with triolein hydrolyzing C-NS strains.
Article
Major components of two tea-tree oil samples were identified using thin layer and gas-liquid chromatography (TLC and GLC). Using a TLC-bioautographic technique, the tea-tree oils, terpinen-4-ol, alpha-terpineol and alpha-pinene were found to be active against Staphylococcus aureus, Staph. epidermidis and Propionibacterium acnes whereas cineole was inactive against these organisms. The MIC values of the three active compounds increased in the order alpha-terpineol < terpinen-4-ol < alpha-pinene for all three micro-organisms. MIC values of the tea-tree oils and terpinen-4-ol were lower for P. acnes than for the two staphylococci. This study supports the use of tea-tree oil in the treatment of acne, and demonstrates that terpinen-4-ol is not the sole active constituent of the oil.
Article
Blepharitis, an intrinsic eyelid inflammation with crusting and irritation, presents a great problem for patients wearing contact lenses. An important part of blepharitis therapy is eyelid hygiene, including the use of either soap, dilute baby shampoo, or commercial lid scrubs. In this study, a comparison was made between these three cleaning regimens in a group of 25 patients, 80% of whom (20/25) wore contact lenses. Patients used commercial eyelid scrub on right eyelids and a hypo-allergenic bar soap on left eyelids. Patient symptoms, slit lamp findings, and overall preferences were determined at the end of 4 months. A subgroup of 10 patients using lid scrub on right eyelids and dilute baby shampoo on left eyelids was followed for an additional 3 months. At the end of 4 months, 24% (6/25) of the patients noted no difference between soap and lid scrub, but 89% (17/19) of the others preferred the lid scrub. In the group using baby shampoo, 50% (5/10) noted no difference in 3 months, but 80% (4/5) of the remaining patients preferred the lid scrub. All patients improved in slit lamp findings with all three regimens, and patient preference was overwhelmingly in favor of the lid scrub regimen for convenience and ease of use.
Article
Excessive numbers of the mite, Demodax folliculorum, in the eyelash follicies cause itching and is referred to as demodicosis. We evaluated 4% pilocarpine gel as a treatment for this condition. An advertisement was placed in a retirement home newsletter, requesting persons with ocular discomfort. Respondents were examined for Demodex and persons with abundant mites were invited to participate. One eye was treated with pilocarpine gel; the other eye was untreated. The relative abundance of mites was evaluated at baseline, after 1 and 2 weeks of treatment. Subjects kept a daily log of symptoms. Eleven of 22 persons with ocular itching had abundant Demodax. Mites were reduced significantly by the treatment (p = 0.017). The amount of mite reduction was closely correlated with the extent to which itching was alleviated (r = 0.811, p = 0.008). Abundant Demodex is an important cause of ocular itching in older persons. Mites can be reduced with pilocarpine gel and itching alleviated.
Article
Previous work on rabbits has demonstrated a four-fold increase in tear evaporation when the tear lipid layer is removed. However, in vitro work has suggested that the lipid layer does not play a role in retarding evaporation of the aqueous layer. The importance of the lipid layer in human tear film stability and evaporation was determined in the current study by measurement of these parameters in the same individuals. The left eyes of 161 normal and dry eye subjects (72 males, 89 females), with an age range of 13 to 85 years, were examined. Tear evaporation was derived from the vapor pressure gradient measured with a modified Servomed evaporimeter. Lipid layer structure and noninvasive break-up time (NIBUT) were assessed clinically, by specular reflection, with the Keeler Tearscope. Lipid layer structure was categorized into marmoreal (open and closed meshwork), flow, amorphous, and colored fringe (normal and abnormal) patterns. These observed patterns reflect lipid layer thickness. Ambient temperature and relative humidity remained fairly constant throughout the experiment. Tear evaporation rate was found to vary significantly with different lipid layer patterns. Eyes with no visible lipid layer, or exhibiting an abnormal colored fringe pattern (with clumping of lipid amidst areas of little or no lipid cover), demonstrated a significantly higher rate of evaporation of the tear film (p < 0.001). There were no significant differences amongst the remainder of the patterns. The NIBUT was also found to vary significantly with lipid layer pattern (p < 0.001), with the absent or abnormal colored fringe lipid patterns exhibiting the poorest stability. Where the human lipid layer is absent, or is not confluent, and the tear film is unstable, tear evaporation is increased four-fold. However, where there is a stable, intact lipid layer, regardless of lipid thickness, tear evaporation is retarded.
Article
To evaluate the validity and reliability of the Ocular Surface Disease Index (OSDI) questionnaire. Participants (109 patients with dry eye and 30 normal controls) completed the OSDI, the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25), the McMonnies Dry Eye Questionnaire, the Short Form-12 (SF-12) Health Status Questionnaire, and an ophthalmic examination including Schirmer tests, tear breakup time, and fluorescein and lissamine green staining. Factor analysis identified 3 subscales of the OSDI: vision-related function, ocular symptoms, and environmental triggers. Reliability (measured by Cronbach alpha) ranged from good to excellent for the overall instrument and each subscale, and test-retest reliability was good to excellent. The OSDI was valid, effectively discriminating between normal, mild to moderate, and severe dry eye disease as defined by both physician's assessment and a composite disease severity score. The OSDI also correlated significantly with the McMonnies questionnaire, the National Eye Institute Visual Functioning Questionnaire, the physical component summary score of the Short Form-12, patient perception of symptoms, and artificial tear usage. The OSDI is a valid and reliable instrument for measuring the severity of dry eye disease, and it possesses the necessary psychometric properties to be used as an end point in clinical trials.
Article
To investigate the in vitro antifungal activity of the components of Melaleuca alternifolia (tea tree) oil. Activity was investigated by broth microdilution and macrodilution, and time kill methods. Components showing the most activity, with minimum inhibitory concentrations and minimum fungicidal concentrations of < or =0.25%, were terpinen-4-ol, alpha-terpineol, linalool, alpha-pinene and beta-pinene, followed by 1,8-cineole. The remaining components showed slightly less activity and had values ranging from 0.5 to 2%, with the exception of beta-myrcene which showed no detectable activity. Susceptibility data generated for several of the least water-soluble components were two or more dilutions lower by macrodilution, compared with microdilution. All tea tree oil components, except beta-myrcene, had antifungal activity. The lack of activity reported for some components by microdilution may be due to these components becoming absorbed into the polystyrene of the microtitre tray. This indicates that plastics are unsuitable as assay vessels for tests with these or similar components. This study has identified that most components of tea tree oil have activity against a range of fungi. However, the measurement of antifungal activity may be significantly influenced by the test method.
Article
Tear volume is reduced in symptomatic contact lens wearers, evaporation of the ocular tear film may be a cause. In this study we have focussed on symptomatic or intolerant subjects and compared their tear film lipid-related features to those tolerant to soft contact lens wear. Fourteen tolerant and 10 intolerant to lens wear subjects were recruited for this study. Intolerance to lens wear was defined as experiencing dryness symptoms in the first 6 hours of lens wear and consequently not being regular lens wearers. Lipid layer appearance was graded on a 0-5 scale, meibomian gland obstruction was observed, and the McMonnies questionnaire completed. Tears were collected without reflex stimulation. Degraded lipid (tear aldehyde content), secretory phospholipase A2 enzyme (sPLA2) concentration and activity and lipocalin concentration were analysed using spectrophotometry to quantify colour reactions and enzyme linked immunosorbent assays. Statistical results were calculated using non-parametric tests (median +/- interquartile range) or chi-squared test. Degradation of polyunsaturated fatty acids and related esters leads to the by-products, malondialdehyde and 4-hydroxy-2(E)-nonenal. Intolerant subjects were found to have significantly (p = 0.004) higher concentrations of these by-products in their tears (0.85 +/- 1.0 microM; n = 9) compared to tolerant subjects (0.15 +/- 0.15 microM; n = 10). Intolerant subjects (1.86 +/- 0.05 ng/microl; n = 9) had significantly more (p = 0.047) sPLA2 enzyme in their tears compared with tolerant subjects (1.80 +/- 0.08 ng/microl; n = 12) and significantly more enzyme activity (p = 0.012). Intolerant subjects had significantly higher amounts of lipocalin in their tears (2.40 +/- 1.5 microg/microl; n = 10, p < 0.001) compared to tolerant subjects (0.45 +/- 0.85 microg/microl; n = 13). Changes to the components of the tear film, however small, can disturb the nature and dynamics of the tear film. Increased lipases, degraded lipids and lipocalins in the aqueous tear film potentiates intolerance to contact lens wear and was associated with increased McMonnies dry eye history scores and symptoms scores.
Article
To report clinical outcome of treating ocular demodecosis by lid scrub with tea tree oil (TTO). Retrospective review of clinical results in 11 patients with ocular Demodex who received weekly lid scrub with 50% TTO combined with daily lid hygiene with tea tree shampoo. These 11 patients also had meibomian gland dysfunction (n = 7) manifesting abnormal lipid film with slow lipid film spread, intermittent trichiasis (n = 5), and subjective lash loss (n = 4), suggesting damage to the meibomian glands and lash follicles. In addition, conjunctival inflammation (n = 8) was associated with conjunctivitis (n = 5), conjunctivochalasis (n = 3), findings suspicious for pemphigoid (n = 2), and recurrent pterygium (n = 2). After TTO lid scrub, the Demodex count dropped to 0 for 2 consecutive visits in less than 4 weeks in 8 of 11 patients. Ten of the 11 patients showed different degrees of symptomatic relief and notable reduction of inflammatory signs. Significant visual improvement in 6 of 22 eyes was associated with a stable lipid tear film caused by significant reduction of lipid spread time. Lid scrub with 50% TTO caused notable irritation in 3 patients. Demodex potentially causes ocular surface inflammation, meibomian gland dysfunction, and lash abnormalities. Lid scrub with TTO can effectively eradicate ocular Demodex and result in subjective and objective improvements. This preliminary positive result warrants future prospective investigation of Demodex pathogenicity.
Article
Dry eye, also known as keratoconjunctivitis sicca, can be due either to insufficient tear production or excessive tear evaporation, both resulting in tear hyperosmolarity that leads to symptoms of discomfort and ocular damage. Additionally, the severity of dry eye symptoms appears to be correlated to lipid layer thickness. It is now generally recognized that increased evaporation due to a compromised lipid layer is one of the most common etiologies for hyperosmolarity of the tear film. Thus, therapies targeted at replenishing or stabilizing the lipid layer are key to the treatment of dry eye, either as monotherapy or in conjunction with therapies designed to enhance aqueous production.
Article
To show whether fluorescein dye helps detect and count Demodex embedded in cylindrical dandruff (CD) of epilated eyelashes from patients with blepharitis. Two eyelashes with CD were removed from each lid of 10 consecutive patients with blepharitis and subjected to microscopic examination with and without fluorescein solution to detect and count Demodex mites. Of 80 eyelashes examined, 36 (45%) lashes retained their CD after removal. Before addition of the fluorescein solution, the mean total Demodex count per patient was 14.9 +/- 10 and the mean Demodex count per lash was 3.1 +/- 2.5 and 0.8 +/- 0.7 in epilated eyelashes with and without retained CD, respectively (P < 0.0001). After addition of the fluorescein solution, opaque and compact CD instantly expanded to reveal embedded mites in a yellowish and semitransparent background. As a result, the mean total Demodex count per patient was significantly increased to 20.2 +/- 13.8 (P = 0.003), and the mean count per lash was significantly increased to 4.4 +/- 2.8 and 1 +/- 0.8 in eyelashes with and without retained CD (P < 0.0001 and P = 0.007), respectively. This new method yielded more mites in 8 of 10 patients and allowed mites to be detected in 3 lashes with retained CD and 1 lash without retained CD that had an initial count of zero. Addition of fluorescein solution after mounting further increases the proficiency of detecting and counting mites embedded in CD of epilated eyelashes.
  • C F Post
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Does the Quality of Vision Affect the Perception of Ocular Discomfort?
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