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    Exploring ocular demodicosis in chronic blepharitis

    Take-home message: By knowing the signs and symptoms of Demodex, ophthalmologists can better diagnose and offer treatments for blepharitis.

    Baltimore—Infestation of Demodex, an ectoparasite often found on human skin, appears to play a part in blepharitis cases—both in younger and older patients (and everyone in between).

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    The clinical significance of such an invasion of mites in blepharitis is up for debate, largely because the infestation also can appear in individuals with no symptoms, according to Esen K. Akpek, MD, professor of ophthalmology, Johns Hopkins University School of Medicine, Baltimore.

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    Dr. Akpek said whether the infestation is significant enough has a tie-in to incidences of blepharitis, and this has led to it sometimes being missed when drawing up differential diagnoses of chronic blepharokeratoconjunctivitis.

    Demodex is often observed in individuals over age 70. The infestation rate is reported to accelerate with age. However, the literature also points to chronic blepharokeratoconjunctivitis being linked to demodicosis in children.

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    “Most everyone above a certain age has Demodex. However, most [do] not react to the presence of this microorganism,” Dr. Akpek said.

    Overall, whether impacting young or old individuals, infestation of Demodex has been tied to several skin problems, including perioral dermatitis, pityriasis, and rosacea.

    Simple hygiene measures can prevent demodex infestations. Courtesy of Esen Akpek, MDWhen affected by Demodex, Dr. Akpek says, “If patients perform daily hygiene measures, they will be fine. This means scrubbing the lids with a detergent such as baby shampoo.”

    She likens the hygiene measure to brushing teeth twice and flossing once a day.

    “Some people do not wash their faces, [so] the microorganism overgrows and causes trouble,” Dr. Akpek said. “Some people are highly sensitive to the presence of the microorganisms and react with a delayed cell-mediated hypersensitivity, then get, for example, corneal involvement.”

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    As for cases involving children, Dr. Akpek said it is important for ophthalmologists to anticipate this condition.

    “It is easy to diagnose if they suspect [it],” she said. “Just lid hygiene [alone is] mostly adequate, but sometimes oral antibiotics are necessary.”

    To watch video of a magnified demodex egg hatching, click here

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