Demodex folliculorum and Demodex brevis are two mites which infest the human eye and which may, in excess, lead to a wide range of anterior segment findings. Demodex mites have been implicated in anterior and posterior blepharitis, blepharoconjunctivitis, blepharokeratitis, and beyond. Due to significant overlap with other anterior segment conditions, Demodex infestation remains underdiagnosed and undertreated. Definitive diagnosis can be made with lash sampling, and the most common mode of treatment is with tea tree oil in varying concentrations. This article summarizes elements of pathogenesis, diagnosis, and management critical to clinical care of this common condition.
Anterior uveitis encompasses inflammation of the iris and/or ciliary body and is one of the most common types of ocular inflammation that primary eye care practitioners will encounter. Anterior uveitis may be caused by a variety of etiologies, including infectious, non-infectious, and masquerade diseases. The short-term and long-term treatment of uveitis should include the evaluation of location, duration, pathology, and laterality, in addition to presenting signs and symptoms of the disease. A complete review of systems, thorough examination, and laboratory testing, may assist the practitioner in narrowing the list of possible causes for the uveitis. This is imperative as once a list of diagnoses has been made, a targeted approach to treatment can be pursued.
Meibomian gland dysfunction (MGD) is commonly encountered among eye care professionals. Our understanding of the pathophysiology for the development of MGD has greatly expanded in recent years, which helped increase awareness of the disease. Despite increased awareness, it is essential for eye care professionals to make a conscious effort to properly examine the meibomian glands through gland expression even for asymptomatic patients. At minimum, early management should include patient education and supportive therapy such as warm compresses, lid hygiene, and gland expression. As patients become more symptomatic and as the ocular surface becomes more affected, employing additional therapeutic management is recommended and may include oral omega-3 essential fatty acids, topical azithromycin, oral tetracycline, and topical anti-inflammatories to improve clinical signs and patient comfort. In addition to treatment of MGD, clinicians should be mindful of the comorbid conditions of MGD and simultaneously manage them in conjunction of MGD treatment.
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